Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XF0002X | Feeding, Eating & Swallowing | 013010-1 | NY |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 013010-1 | NY |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 013010-1 | NY |
NPI | 1770808602 |
---|---|
Provider Name | Mona Mallemat |
First Address | Bayside, NY 11361-1059 |
Second Address | Bayside, NY 11361-1059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2010 |
Last Update Date | 04/04/2010 |