Provider Demographics
NPI:1356537526
Name:MALLOY, KATHLEEN JUDE (OTRL)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:JUDE
Last Name:MALLOY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 W 129TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3415
Mailing Address - Country:US
Mailing Address - Phone:216-941-1521
Mailing Address - Fax:
Practice Address - Street 1:20265 EMERY RD
Practice Address - Street 2:
Practice Address - City:NORTH RANDALL
Practice Address - State:OH
Practice Address - Zip Code:44128-4122
Practice Address - Country:US
Practice Address - Phone:216-475-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.006976225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist