Provider Demographics
NPI:1932872157
Name:MAHONEY, EMILY ANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:MAHONEY
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 1:58 ASH ST APT 2N
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-4989
Mailing Address - Country:US
Mailing Address - Phone:315-406-8573
Mailing Address - Fax:
Practice Address - Street 1:191 PEACHAM RD
Practice Address - Street 2:
Practice Address - City:CENTER BARNSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03225-3860
Practice Address - Country:US
Practice Address - Phone:315-406-8573
Practice Address - Fax:603-776-0381
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3192225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist