Provider Demographics
NPI:1326619305
Name:HARKAVY, MOLLIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:HARKAVY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 INGLEWOOD AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4112
Mailing Address - Country:US
Mailing Address - Phone:952-738-2749
Mailing Address - Fax:
Practice Address - Street 1:6200 XERXES AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55423-1033
Practice Address - Country:US
Practice Address - Phone:952-925-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN202260224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant