Healthcare Provider Details

I. General information

NPI: 1780564427
Provider Name (Legal Business Name): MOLLY KATHERINE FRASER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MUZZEY ST
LEXINGTON MA
02421-5256
US

IV. Provider business mailing address

19 MUZZEY ST
LEXINGTON MA
02421-5256
US

V. Phone/Fax

Practice location:
  • Phone: 978-237-4937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15473
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: