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NPI Code Detail

MEDICARE: MS. MOLLY ANN EVANS MOT, OTR/L

MEDICARE: MS. MOLLY ANN EVANS 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
1225X00000XOccupational TherapistOT010093OH

General Provider Information

NPI Number : 1508367467
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MOLLY ANN EVANS MOT, OTR/L
Provider Business Mailing Address
First Line : 1100 SHAWNEE RD
Second Line :
City : LIMA
State : OH
Zip : 45805-3583
Country : US
Telephone Number : 419-999-2010
Fax Number : 419-999-6284
Provider Business Practice Location Address
First Line : 2651 FORT AMANDA RD
Second Line :
City : LIMA
State : OH
Zip : 45804-3730
Country : US
Telephone Number : 419-228-8412
Fax Number : 419-228-8612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2018
Last Update Date : 05/24/2021

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