Basic Information
| Provider Information | |||||||||
| NPI: | 1356537526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALLOY | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | JUDE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTRL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3611 W 129TH ST | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441113415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169411521 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20265 EMERY RD | ||||||||
| Address2: | |||||||||
| City: | NORTH RANDALL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441284122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164758880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2007 | ||||||||
| LastUpdateDate: | 09/20/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT.006976 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.