Healthcare Provider Details

I. General information

NPI: 1609782028
Provider Name (Legal Business Name): MOLLY JANE PATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 SAINT JOSEPH AVE
BERRIEN SPRINGS MI
49103-1583
US

IV. Provider business mailing address

4598 E SHAWNEE RD
BERRIEN SPRINGS MI
49103-9770
US

V. Phone/Fax

Practice location:
  • Phone: 269-471-7725
  • Fax:
Mailing address:
  • Phone: 269-470-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: