Individual
MISS MALLORY MCBREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2200 1ST AVE, POTTSVILLE, PA 17901-2065
(570) 628-6950
(570) 628-4874
Mailing address
353 1ST ST, PORT CARBON, PA 17965-1637
(570) 292-1063
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP006641
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OP006641
PENNSYLVANIA STATE LICENSE
PA
Enumeration date
12/04/2008
Last updated
12/04/2008
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