Provider Demographics
NPI:1245542943
Name:MALLEY, DARLENE MARIA (COTA/L)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:MARIA
Last Name:MALLEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14502 GREENVIEW DR STE 406
Mailing Address - Street 2:SUPPLEMENTAL HEALTH CARE
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708
Mailing Address - Country:US
Mailing Address - Phone:866-566-5310
Mailing Address - Fax:866-566-5311
Practice Address - Street 1:7602 MCNAMARA DR.
Practice Address - Street 2:DARLENE MALLEY
Practice Address - City:GLENBURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:866-566-5310
Practice Address - Fax:866-566-5311
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00-531224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant