Individual
DANIEL MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5601 HATCHERY RD, 248) 674-9292, WATERFORD, MI 48329-3451
(248) 674-9292
Mailing address
5455 VICTORIA BLVD APT 33, WATERFORD, MI 48327-3180
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202007829
MI
Other
Enumeration date
08/20/2014
Last updated
08/20/2014
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