Provider Demographics
NPI:1649654849
Name:HARRIS, MOLLY OEXMANN (ATC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:OEXMANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 HEADFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1659
Mailing Address - Country:US
Mailing Address - Phone:980-322-1392
Mailing Address - Fax:
Practice Address - Street 1:8401 HEADFORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-1659
Practice Address - Country:US
Practice Address - Phone:980-322-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer