MEDICARE: MOLLIE SHEEHY OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OC01891	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30863098	OTHER	PA	DRIVERS LICENSE

General Provider Information

NPI Number	:	1013626605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLIE SHEEHY OTR/L

Provider Business Mailing Address
First Line	:	18 TREELINE DR
Second Line	:
City	:	HOLLAND
State	:	PA
Zip	:	18966-2835
Country	:	US
Telephone Number	:	215-850-9840
Fax Number	:

Provider Business Practice Location Address
First Line	:	1804 BAINBRIDGE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1807
Country	:	US
Telephone Number	:	215-850-9840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2022
Last Update Date	:	11/22/2022

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