Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XM0800X | Mental Health |
NPI | 1730362450 |
---|---|
Provider Name | Kimberly S Mollo |
First Address | Lafayette Hill, PA 19444-1800 |
Second Address | Lafayette Hill, PA 19444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2007 |
Last Update Date | 14/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022381 | NEW YORK LICENSE (01) | NY |
46TR00443400 | OCCUPATIONAL THERAPY LICENSURE (01) | NJ |
OC010410 | OCCUPATIONAL THERAPY LICENSURE (01) | PA |
U1-0001454 | DELAWARE LICENSURE (01) | DE |