Provider Demographics
NPI:1639860869
Name:WYMAN, MOLLEIGH (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:MOLLEIGH
Middle Name:
Last Name:WYMAN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:CANDIA
Mailing Address - State:NH
Mailing Address - Zip Code:03034-2510
Mailing Address - Country:US
Mailing Address - Phone:603-370-8807
Mailing Address - Fax:
Practice Address - Street 1:30 HARVEY RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6818
Practice Address - Country:US
Practice Address - Phone:603-296-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist