=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962239764
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOLLY MCLANE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2024
-----------------------------------------------------
Last Update Date | 09/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 PHEASANT RUN STE 215
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18940-1886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-550-6109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 INVERNESS CIR
-----------------------------------------------------
City | CHALFONT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18914-3955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-664-2010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OC020205
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------