Provider Demographics
NPI:1659841559
Name:MOLLEN, MARY JEAN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MARY JEAN
Middle Name:
Last Name:MOLLEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 MERMAID DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-4779
Mailing Address - Country:US
Mailing Address - Phone:410-507-6088
Mailing Address - Fax:
Practice Address - Street 1:202 CHESTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-1308
Practice Address - Country:US
Practice Address - Phone:410-758-2403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03301225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist