Provider Demographics
NPI:1073145272
Name:MOLAISON, HEIDI DRYDEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:DRYDEN
Last Name:MOLAISON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 HIGHWAY 11 N STE E
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-2070
Mailing Address - Country:US
Mailing Address - Phone:769-242-2626
Mailing Address - Fax:769-242-2685
Practice Address - Street 1:1620 HIGHWAY 11 N STE E
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2070
Practice Address - Country:US
Practice Address - Phone:769-242-2626
Practice Address - Fax:769-242-2685
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT-331225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist