Individual
MIMI LYNN MALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
517 S ERIE ST, THREE RIVERS, MI 49093-2029
(269) 273-8661
Mailing address
517 S ERIE ST, THREE RIVERS, MI 49093-2029
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
5201003014
MI
Other
Enumeration date
12/11/2018
Last updated
12/11/2018
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