Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1629339288 |
---|---|
Provider Name | Ms. Stephanie Paige Molter |
First Address | Collinsville, IL 62234-6044 |
Second Address | Cahokia, IL 62206-2204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 30/05/2012 |