Provider Demographics
NPI:1386216653
Name:MOLITOR, CASSIDY (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:MOLITOR
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:
Other - Last Name:MOHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:950 OFFICE PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2549
Mailing Address - Country:US
Mailing Address - Phone:515-224-0979
Mailing Address - Fax:515-223-3862
Practice Address - Street 1:950 OFFICE PARK RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2548
Practice Address - Country:US
Practice Address - Phone:515-224-0979
Practice Address - Fax:515-223-3862
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA109208225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist