Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 10030 | MA |
N | 225X00000X | Occupational Therapist | 3782 | SC |
NPI | 1003109174 |
---|---|
Provider Name | Andrea Malloch-Swiderski |
First Address | Falmouth, MA 02540-5103 |
Second Address | Falmouth, MA 02540-5103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2011 |
Last Update Date | 21/09/2016 |