Provider Demographics
NPI:1073988275
Name:COE, MOLLIE (AT)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:COE
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 HIDEAWAY VALLEY DR
Mailing Address - Street 2:UNIT 12
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-8400
Mailing Address - Country:US
Mailing Address - Phone:231-330-1412
Mailing Address - Fax:231-238-2303
Practice Address - Street 1:1185 HIDEAWAY VALLEY DR
Practice Address - Street 2:UNIT 12
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-8400
Practice Address - Country:US
Practice Address - Phone:231-330-1412
Practice Address - Fax:231-238-2303
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010003712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer