Provider Demographics
NPI:1407256803
Name:CERRITO, MOLLY DANIELLE
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:DANIELLE
Last Name:CERRITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 S YALE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7816
Mailing Address - Country:US
Mailing Address - Phone:918-494-9300
Mailing Address - Fax:918-494-9355
Practice Address - Street 1:6475 S YALE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7816
Practice Address - Country:US
Practice Address - Phone:918-494-9300
Practice Address - Fax:918-494-9355
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK778OtherOKLAHOMA STATE BOARD OF MEDICAL LICENSURE AND SUPERVISION