Provider Demographics
NPI:1326260746
Name:HUBEN, MOLLY ANN (OT, CEES)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:ANN
Last Name:HUBEN
Suffix:
Gender:F
Credentials:OT, CEES
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANN
Other - Last Name:MEADOWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:2820 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-3834
Practice Address - Country:US
Practice Address - Phone:715-735-5225
Practice Address - Fax:715-735-5388
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3240-026225X00000X, 225XE1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40836400Medicaid
WI3240-026OtherOCCUPATIONAL THERAPIST