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Individual

HUNTER EDWARD MALL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
COTA

Contact information

Practice address
264 JEFFERSONVILLE NORTH BRANCH RD, JEFFERSONVILLE, NY 12748-5624
(845) 796-8200
Mailing address
264 JEFFERSONVILLE NORTH BRANCH RD, JEFFERSONVILLE, NY 12748-5624
(845) 796-8200

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
011568
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
011568
NEW YORK STATE LICENSE
NY
Enumeration date
07/01/2024
Last updated
07/01/2024
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