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General NPI Number Information
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NPI Number | 1427760222
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Entity Type | Individual
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Provider Name | MOLLY MARIE MARN OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/23/2022
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Last Update Date | 12/23/2022
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Provider Practice Location Address
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Address Line | 2885 10 MILE RD NE
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City | ROCKFORD
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State | MI
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Zip | 49341-9177
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Country | US
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Telephone | 616-947-3046
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Fax |
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Provider Business Mailing Address
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Address Line | 201 FULTON ST W
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-6201
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Country | US
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Telephone | 248-659-2645
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201013192
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License Number State | MI
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