Provider Demographics
NPI:1144710989
Name:MALLOZZI, ELIZABETH ANNE (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:MALLOZZI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 EUSTON RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1202
Mailing Address - Country:US
Mailing Address - Phone:516-780-2235
Mailing Address - Fax:
Practice Address - Street 1:160 EUSTON RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1202
Practice Address - Country:US
Practice Address - Phone:516-780-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022489225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist