Provider Demographics
NPI:1104357409
Name:SWINDELL, MOLLIE MARIE
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:MARIE
Last Name:SWINDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 KENWOOD AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-2032
Mailing Address - Country:US
Mailing Address - Phone:443-540-0145
Mailing Address - Fax:
Practice Address - Street 1:4405 KENWOOD AVE UNIT A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-2032
Practice Address - Country:US
Practice Address - Phone:443-540-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer