Provider Demographics
NPI:1023597150
Name:JAMES, MOLLY ANN (MOTR/L)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:JAMES
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANN
Other - Last Name:ADDISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:11000 W MCNICHOLS RD STE 320
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2357
Mailing Address - Country:US
Mailing Address - Phone:313-340-4442
Mailing Address - Fax:
Practice Address - Street 1:11000 W MCNICHOLS RD STE 320
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2357
Practice Address - Country:US
Practice Address - Phone:313-340-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008525225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist