Provider Demographics
NPI:1225789555
Name:CASE, MOLLY ROSE-FULLER (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ROSE-FULLER
Last Name:CASE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 ELM ST STE 304
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4540
Mailing Address - Country:US
Mailing Address - Phone:702-209-4863
Mailing Address - Fax:
Practice Address - Street 1:343 ELM ST STE 304
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4540
Practice Address - Country:US
Practice Address - Phone:702-209-4863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-2899225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics