Provider Demographics
NPI:1659444818
Name:MUNN, MALA O (OTRL,CHT)
Entity type:Individual
Prefix:
First Name:MALA
Middle Name:O
Last Name:MUNN
Suffix:
Gender:F
Credentials:OTRL,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-0673
Mailing Address - Country:US
Mailing Address - Phone:803-438-9362
Mailing Address - Fax:
Practice Address - Street 1:9600 TWO NOTCH RD.
Practice Address - Street 2:SUITE 24
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-1613
Practice Address - Country:US
Practice Address - Phone:803-736-5540
Practice Address - Fax:803-699-0951
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC243225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand