Provider Demographics
NPI:1881912970
Name:GROSSMAN FRIAS, MOLLY (MA, OTR/L)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:GROSSMAN FRIAS
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:GROSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, OTR/L
Mailing Address - Street 1:1637 E MAPLE AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3311
Mailing Address - Country:US
Mailing Address - Phone:954-651-5540
Mailing Address - Fax:
Practice Address - Street 1:1815 W. 213TH ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2852
Practice Address - Country:US
Practice Address - Phone:310-328-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist