Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 00745 | IA |
NPI | 1003854027 |
---|---|
Provider Name | Therese B Molloy |
First Address | Cedar Rapids, IA 52402-1448 |
Second Address | Iowa City, IA 52240-4249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 20/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00745 | IOWA OT LICENSE (01) | IA |
I10654 | (02) | IA |