Provider Demographics
NPI:1669249660
Name:CORRIGAN, MOLLY ANNABELLE
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANNABELLE
Last Name:CORRIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-5417
Mailing Address - Country:US
Mailing Address - Phone:215-630-2703
Mailing Address - Fax:
Practice Address - Street 1:200 LAKESIDE DR STE 228
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2321
Practice Address - Country:US
Practice Address - Phone:215-259-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019634225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist