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NPI Code Detail

MEDICARE: MOLLIE CHAINANI BIVENS MOT, OTR/L

MEDICARE: MOLLIE CHAINANI BIVENS MOT, 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
1225XP0200XPediatric Occupational TherapistOT 8048CA
2225XP0200XPediatric Occupational Therapist8048CA

General Provider Information

NPI Number : 1467871897
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLIE CHAINANI BIVENS MOT, OTR/L
Provider Business Mailing Address
First Line : 805 AEROVISTA PL STE 101
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-7921
Country : US
Telephone Number : 805-996-0899
Fax Number : 805-250-3089
Provider Business Practice Location Address
First Line : 805 AEROVISTA PL STE 101
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-7921
Country : US
Telephone Number : 805-996-0899
Fax Number : 805-250-3089
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2014
Last Update Date : 01/09/2023

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