Provider Demographics
NPI:1144748419
Name:FASH, MOLLY
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:FASH
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 1:3303 HORSE PEN CREEK RD UNIT 3E
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9807
Mailing Address - Country:US
Mailing Address - Phone:908-307-6249
Mailing Address - Fax:
Practice Address - Street 1:5229 APPOMATTOX RD
Practice Address - Street 2:
Practice Address - City:PLEASANT GARDEN
Practice Address - State:NC
Practice Address - Zip Code:27313-8202
Practice Address - Country:US
Practice Address - Phone:336-674-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11121225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist