Healthcare Provider Details

I. General information

NPI: 1700781911
Provider Name (Legal Business Name): MOLLY BROWN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 N NEW ST
STANTON MI
48888-9459
US

IV. Provider business mailing address

9465 GRENDLUND RD
CARSON CITY MI
48811-9617
US

V. Phone/Fax

Practice location:
  • Phone: 989-640-5961
  • Fax:
Mailing address:
  • Phone: 989-640-5961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201013103
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: