Provider Demographics
NPI:1831445121
Name:MOLLOHAN, CHARLOTTE (COTA/L)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:MOLLOHAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 CHESHIRE LN
Mailing Address - Street 2:APT D
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-3910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3433 CHESHIRE LN
Practice Address - Street 2:APT D
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-3910
Practice Address - Country:US
Practice Address - Phone:727-642-9962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 9988314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility