Healthcare Provider Details

I. General information

NPI: 1326260746
Provider Name (Legal Business Name): MOLLY ANN HUBEN OT, CEES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MOLLY ANN MEADOWS OT

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 ROOSEVELT RD
MARINETTE WI
54143-3834
US

IV. Provider business mailing address

PO BOX 22487
GREEN BAY WI
54305-2487
US

V. Phone/Fax

Practice location:
  • Phone: 715-735-5225
  • Fax: 715-735-5388
Mailing address:
  • Phone: 920-445-7222
  • Fax: 920-445-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3240-026
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number3240-026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: