Provider Demographics
NPI:1932789724
Name:RIPPLE, MOLLIE MICHELLE (MOT, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:MOLLIE
Middle Name:MICHELLE
Last Name:RIPPLE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-4946
Mailing Address - Country:US
Mailing Address - Phone:817-727-7547
Mailing Address - Fax:
Practice Address - Street 1:6203 COLLEYVILLE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8000
Practice Address - Country:US
Practice Address - Phone:817-697-7856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121341225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist