Provider Demographics
NPI:1356051932
Name:KRAFT, MOLLY RAYE
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:RAYE
Last Name:KRAFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 BROWNLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3928
Mailing Address - Country:US
Mailing Address - Phone:937-474-7855
Mailing Address - Fax:
Practice Address - Street 1:1540 BROWNLEIGH RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-3928
Practice Address - Country:US
Practice Address - Phone:937-474-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management