Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 017135-1 | NY |
NPI | 1164848784 |
---|---|
Provider Name | Mrs. Melissa Mahony |
First Address | Monroe, NY 10950-4539 |
Second Address | West Haverstraw, NY 10993 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2014 |
Last Update Date | 06/03/2014 |