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General NPI Number Information
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NPI Number | 1699355107
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Entity Type | Individual
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Provider Name | MOLLI MOTTI
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Gender | Female
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 10450 185TH ST W STE 100
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City | LAKEVILLE
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State | MN
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Zip | 55044-6696
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Country | US
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Telephone | 904-868-6039
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Fax |
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Provider Business Mailing Address
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Address Line | 23310 MAIN ST APT 3
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City | HAMPTON
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State | MN
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Zip | 55031-8783
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Country | US
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Telephone | 904-868-6039
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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