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General NPI Number Information
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NPI Number | 1891755773
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Entity Type | Individual
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Provider Name | MOLLY BRIGITA GANT IV
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Gender | Female
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 502 N MACARTHUR AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-3636
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Country | US
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Telephone | 850-769-9008
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Fax |
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Provider Business Mailing Address
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Address Line | 161 CONCORD CIR
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City | PANAMA CITY
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State | FL
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Zip | 32405-3557
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Country | US
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Telephone | 850-303-1536
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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 | OT11516
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License Number State | FL
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