Provider Demographics
NPI:1467871897
Name:BIVENS, MOLLIE CHAINANI (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:CHAINANI
Last Name:BIVENS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 AEROVISTA PL STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7921
Mailing Address - Country:US
Mailing Address - Phone:805-996-0899
Mailing Address - Fax:805-250-3089
Practice Address - Street 1:805 AEROVISTA PL STE 101
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7921
Practice Address - Country:US
Practice Address - Phone:805-996-0899
Practice Address - Fax:805-250-3089
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 8048225XP0200X
CA8048225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics