Provider Demographics
NPI:1629612965
Name:KESSLER, MOLLY ELAINE SULLIVAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ELAINE SULLIVAN
Last Name:KESSLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ELAINE
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 SOUTH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2306
Mailing Address - Country:US
Mailing Address - Phone:425-615-4974
Mailing Address - Fax:
Practice Address - Street 1:212 SOUTH ST FL 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-2306
Practice Address - Country:US
Practice Address - Phone:425-615-4974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0002094225X00000X
PAOC016609225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist