Provider Demographics
NPI:1649525924
Name:MALONEY, SUSAN MARGARET (MOT, PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARGARET
Last Name:MALONEY
Suffix:
Gender:F
Credentials:MOT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 EDGEWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-2435
Mailing Address - Country:US
Mailing Address - Phone:314-402-1634
Mailing Address - Fax:
Practice Address - Street 1:1010 EDGEWORTH AVE
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-2435
Practice Address - Country:US
Practice Address - Phone:314-402-1634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011027107225X00000X, 225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist