Provider Demographics
NPI:1437616315
Name:THORESON, MOLLIE
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:THORESON
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 1:14281 SWEETBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:NOVELTY
Mailing Address - State:OH
Mailing Address - Zip Code:44072-9787
Mailing Address - Country:US
Mailing Address - Phone:440-214-2562
Mailing Address - Fax:
Practice Address - Street 1:14281 SWEETBRIAR LN
Practice Address - Street 2:
Practice Address - City:NOVELTY
Practice Address - State:OH
Practice Address - Zip Code:44072-9787
Practice Address - Country:US
Practice Address - Phone:440-214-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer