Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 2011027107 | MO |
Y | 225XM0800X | Mental Health | 2011027107 | MO |
NPI | 1649525924 |
---|---|
Provider Name | Dr. Susan Margaret Maloney |
First Address | Kirkwood, MO 63122-2435 |
Second Address | Kirkwood, MO 63122-2435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2012 |
Last Update Date | 23/07/2012 |