Provider Demographics
NPI:1942710777
Name:MALLIA, DANIELA ROSE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:ROSE
Last Name:MALLIA
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 ELTINGVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2108
Mailing Address - Country:US
Mailing Address - Phone:718-909-5746
Mailing Address - Fax:
Practice Address - Street 1:454 ELTINGVILLE BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2108
Practice Address - Country:US
Practice Address - Phone:718-909-5746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021925225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist