Provider Demographics
NPI:1366704371
Name:MALLEY, SHIRLYN R (OTR)
Entity type:Individual
Prefix:
First Name:SHIRLYN
Middle Name:R
Last Name:MALLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SHIRLYN
Other - Middle Name:ROSAFORTE
Other - Last Name:MALLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6347 W JUDY AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-0814
Mailing Address - Country:US
Mailing Address - Phone:559-737-3790
Mailing Address - Fax:559-735-0873
Practice Address - Street 1:264 N WESTWOOD ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-2542
Practice Address - Country:US
Practice Address - Phone:559-737-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6265171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor