Healthcare Provider Details

I. General information

NPI: 1710842299
Provider Name (Legal Business Name): KELLY MOLLOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S MAIN ST
RICHLANDTOWN PA
18955-1014
US

IV. Provider business mailing address

125 STAYMAN DR
NORTH WALES PA
19454-1433
US

V. Phone/Fax

Practice location:
  • Phone: 267-371-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOC015703
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: