Provider Demographics
NPI:1912141961
Name:MALIA, DENA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:MARIE
Last Name:MALIA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8919 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-7629
Mailing Address - Country:US
Mailing Address - Phone:704-551-7100
Mailing Address - Fax:704-295-0013
Practice Address - Street 1:8919 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-7629
Practice Address - Country:US
Practice Address - Phone:704-551-7100
Practice Address - Fax:704-295-0013
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4786174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist