Provider Demographics
NPI:1881343044
Name:ORTEGA, MOLLY (MOT)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 S HIGHWAY 377
Mailing Address - Street 2:
Mailing Address - City:PILOT POINT
Mailing Address - State:TX
Mailing Address - Zip Code:76258-4355
Mailing Address - Country:US
Mailing Address - Phone:866-832-1708
Mailing Address - Fax:888-789-4391
Practice Address - Street 1:6434 98TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-5468
Practice Address - Country:US
Practice Address - Phone:866-832-1708
Practice Address - Fax:888-789-4391
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX467188225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist