Provider Demographics
NPI:1356760086
Name:GENOVESE, MOLLY (MOT, OTR)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:GENOVESE
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9737 GREAT HILLS TRL
Mailing Address - Street 2:#120
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-6417
Mailing Address - Country:US
Mailing Address - Phone:512-872-2180
Mailing Address - Fax:
Practice Address - Street 1:9737 GREAT HILLS TRL
Practice Address - Street 2:#120
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-6417
Practice Address - Country:US
Practice Address - Phone:512-872-2180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116088225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist