Provider Demographics
NPI:1871863563
Name:RACKLIN, MOLLY LISA (OTR/L, CBIS)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:LISA
Last Name:RACKLIN
Suffix:
Gender:F
Credentials:OTR/L, CBIS
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:LISA
Other - Last Name:RUBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, CBIS
Mailing Address - Street 1:20000 VICTOR PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-7029
Mailing Address - Country:US
Mailing Address - Phone:734-953-1745
Mailing Address - Fax:734-953-1743
Practice Address - Street 1:20000 VICTOR PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-7029
Practice Address - Country:US
Practice Address - Phone:734-953-1745
Practice Address - Fax:734-953-1743
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006994225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist