Healthcare Provider Details

I. General information

NPI: 1932890415
Provider Name (Legal Business Name): MOLLY DALZIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 E WALNUT ST
PASADENA CA
91106-1720
US

IV. Provider business mailing address

913 E WALNUT ST
PASADENA CA
91106-1720
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-7910
  • Fax: 626-795-7912
Mailing address:
  • Phone: 626-795-7910
  • Fax: 626-795-7912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number25762
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number25762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: