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General NPI Number Information
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NPI Number | 1619480894
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Entity Type | Individual
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Provider Name | MOLLY JEAN HOVENDICK ATC
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Gender | Female
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Dates
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Enumeration Date | 11/10/2017
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | SOUTH DIVISION STREET
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City | FORT LEWIS
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State | WA
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Zip | 98433
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Country | US
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Telephone | 307-349-0650
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Fax |
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Provider Business Mailing Address
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Address Line | 8569 HIGHWAY 789
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City | LANDER
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State | WY
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Zip | 82520-9474
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | A161600256
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1008
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License Number State | OK
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