Provider Demographics
NPI:1457960841
Name:MCGREAL-STENCE, MOLLY CATHERINE (OT/L)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:CATHERINE
Last Name:MCGREAL-STENCE
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:CATHERINE
Other - Last Name:MCGREAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT/L
Mailing Address - Street 1:4319 INGERSOLL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-2413
Mailing Address - Country:US
Mailing Address - Phone:515-441-9580
Mailing Address - Fax:
Practice Address - Street 1:6901 PECKHAM ST
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-3143
Practice Address - Country:US
Practice Address - Phone:515-253-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01356225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontologyGroup - Single Specialty