Healthcare Provider Details

I. General information

NPI: 1902251713
Provider Name (Legal Business Name): MOLLY BREEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CHURCH ST
LAKE PLACID NY
12946-1805
US

IV. Provider business mailing address

10 BEECHER RD
COXSACKIE NY
12051-3111
US

V. Phone/Fax

Practice location:
  • Phone: 518-523-8580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number020357
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: