Individual
MARY ELLEN MALLOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
17280 W NORTH AVE, 104, BROOKFIELD, WI 53045-4366
(262) 780-0707
Mailing address
17280 W NORTH AVE, 104, BROOKFIELD, WI 53045-4366
(262) 780-0707
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1191
WI
Other
Enumeration date
01/25/2007
Last updated
07/08/2007
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