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General NPI Number Information
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NPI Number | 1730362450
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Entity Type | Individual
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Provider Name | KIMBERLY S MOLLO OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 06/14/2019
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Provider Practice Location Address
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Address Line | 600 GERMANTOWN PIKE STE A
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City | LAFAYETTE HILL
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State | PA
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Zip | 19444
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Country | US
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Telephone | 215-290-0817
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Fax |
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Provider Business Mailing Address
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Address Line | 600 GERMANTOWN PIKE STE A
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City | LAFAYETTE HILL
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State | PA
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Zip | 19444-1800
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Country | US
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Telephone | 215-290-0817
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | U1-0001454
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 46TR00443400
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OC010410
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License Number State | PA
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