Provider Demographics
NPI:1306357413
Name:WILKINSON, MOLLIE GRACE ANN (COTA/L)
Entity Type:Individual
Prefix:
First Name:MOLLIE GRACE
Middle Name:ANN
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:MOLLIE GRACE
Other - Middle Name:
Other - Last Name:REDDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:369 DEERWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-6601
Mailing Address - Country:US
Mailing Address - Phone:479-650-1124
Mailing Address - Fax:
Practice Address - Street 1:9220 HIGHWAY 71 S STE 10
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-9151
Practice Address - Country:US
Practice Address - Phone:479-763-1412
Practice Address - Fax:479-763-1425
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1945224Z00000X
AROT-A1268224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant