Provider Demographics
NPI:1124039433
Name:CRAWFORD, MOLLY KAY (OT)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:KAY
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:MOLLY
Other - Middle Name:KAY
Other - Last Name:GRUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:4850 LEMAY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1576
Mailing Address - Country:US
Mailing Address - Phone:314-416-0439
Mailing Address - Fax:314-416-7626
Practice Address - Street 1:12639 OLD TESSON RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2786
Practice Address - Country:US
Practice Address - Phone:314-842-3968
Practice Address - Fax:314-842-5236
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001907225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist