MEDICARE: MOLLY JO COLLINS

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	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699465351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY JO COLLINS

Provider Business Mailing Address
First Line	:	122 1/2 14TH ST
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003-3407
Country	:	US
Telephone Number	:	681-296-3613
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 1/2 14TH ST
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003-3407
Country	:	US
Telephone Number	:	681-296-3613
Fax Number	:

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

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/08/2023

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Directions to “ MOLLY JO COLLINS ” Practice Location

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