Provider Demographics
NPI:1912131103
Name:MALLOY, JOHN (MOT, BS,OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:MALLOY
Suffix:
Gender:M
Credentials:MOT, BS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CENTRAL BLVD E
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2007
Mailing Address - Country:US
Mailing Address - Phone:732-202-1285
Mailing Address - Fax:
Practice Address - Street 1:44 PINE ST
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-7710
Practice Address - Country:US
Practice Address - Phone:732-918-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00292500225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation