Provider Demographics
NPI:1669741948
Name:MALANOSKY, AMBER DAWN (COTA/L)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:MALANOSKY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SCENERY HILL
Mailing Address - State:PA
Mailing Address - Zip Code:15360-1511
Mailing Address - Country:US
Mailing Address - Phone:724-809-4126
Mailing Address - Fax:
Practice Address - Street 1:2400 WEST RUN ROAD
Practice Address - Street 2:
Practice Address - City:MUNHALL
Practice Address - State:PA
Practice Address - Zip Code:15120-3346
Practice Address - Country:US
Practice Address - Phone:724-809-4126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01521224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant