MEDICARE: MOLLY TEAGARDIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	15969	CA

General Provider Information

NPI Number	:	1831555382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY TEAGARDIN

Provider Business Mailing Address
First Line	:	26705 BRUSH ST
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3520
Country	:	US
Telephone Number	:	248-561-1619
Fax Number	:

Provider Business Practice Location Address
First Line	:	26705 BRUSH ST
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3520
Country	:	US
Telephone Number	:	248-561-1619
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2016
Last Update Date	:	01/13/2016

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