Provider Demographics
NPI:1770335804
Name:HYNUM, MOLLY UPCHURCCH (OTDL/R)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:UPCHURCCH
Last Name:HYNUM
Suffix:
Gender:F
Credentials:OTDL/R
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:RENEE
Other - Last Name:UPCHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTDL/R
Mailing Address - Street 1:27 LAKE FORGETFUL APT 631
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8286
Mailing Address - Country:US
Mailing Address - Phone:662-588-9353
Mailing Address - Fax:
Practice Address - Street 1:217 METHODIST BLVD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1338
Practice Address - Country:US
Practice Address - Phone:601-329-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT-3962225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist