Provider Demographics
NPI:1457181752
Name:LINDQUIST, MOLLY BURNETTA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:BURNETTA
Last Name:LINDQUIST
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 BRIGHT STAR ST
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1004
Mailing Address - Country:US
Mailing Address - Phone:805-630-2414
Mailing Address - Fax:
Practice Address - Street 1:2625 TOWNSGATE RD STE 102
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5726
Practice Address - Country:US
Practice Address - Phone:805-413-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26701225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist