Provider Demographics
NPI:1689865909
Name:PARKER, MOLLY AVA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:AVA
Last Name:PARKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:MOLLY
Other - Middle Name:AVA
Other - Last Name:DI GIOVENALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMY
Mailing Address - Street 1:30 ARROWHEAD DRIVE
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-2151
Mailing Address - Country:US
Mailing Address - Phone:513-886-5477
Mailing Address - Fax:
Practice Address - Street 1:30 ARROWHEAD DRIVE
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-2151
Practice Address - Country:US
Practice Address - Phone:513-886-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12837225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist