Provider Demographics
NPI:1578629549
Name:MOLNAR, HEATHER L (AT,ATC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:MOLNAR
Suffix:
Gender:F
Credentials:AT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18165 TRILLIUM DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1577
Mailing Address - Country:US
Mailing Address - Phone:616-901-5366
Mailing Address - Fax:
Practice Address - Street 1:18165 TRILLIUM DR
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-1577
Practice Address - Country:US
Practice Address - Phone:616-901-5366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010008572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer