Provider Demographics
NPI:1497471429
Name:DONAHUE, MOLLY (COTA/L)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:DONAHUE
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 1:20692 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-1431
Mailing Address - Country:US
Mailing Address - Phone:440-476-7783
Mailing Address - Fax:
Practice Address - Street 1:6638 MILL ROAD, BRECKSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141
Practice Address - Country:US
Practice Address - Phone:440-740-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA008275224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant