Provider Demographics
NPI:1942547013
Name:O'MALLEY, JOSEPH EDWARD (OTR/L, ABDA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EDWARD
Last Name:O'MALLEY
Suffix:
Gender:M
Credentials:OTR/L, ABDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CHARLES CIR
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3168
Mailing Address - Country:US
Mailing Address - Phone:570-650-3664
Mailing Address - Fax:866-312-5611
Practice Address - Street 1:510 CHARLES CIR
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3168
Practice Address - Country:US
Practice Address - Phone:570-650-3664
Practice Address - Fax:866-312-5611
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002599L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist