Provider Demographics
NPI:1184398612
Name:WILLIAMSON, MOLLY GRACE (PTA)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:GRACE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:GRACE
Other - Last Name:FRENCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 NE 71ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-9300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 NE 71ST ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-9300
Practice Address - Country:US
Practice Address - Phone:541-574-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9993225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant