Healthcare Provider Details

I. General information

NPI: 1245152883
Provider Name (Legal Business Name): MOLLY ELIZABETH UMANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 MOCKINGBIRD LN
GREENDALE WI
53129-1442
US

IV. Provider business mailing address

6203 W WELLS ST
WAUWATOSA WI
53213-3247
US

V. Phone/Fax

Practice location:
  • Phone: 414-421-9600
  • Fax:
Mailing address:
  • Phone: 920-382-1798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number23766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: