Provider Demographics
NPI:1306137971
Name:WUEBKER, MOLLY (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:WUEBKER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 229TH PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-6322
Mailing Address - Country:US
Mailing Address - Phone:515-450-6540
Mailing Address - Fax:
Practice Address - Street 1:5406 MERLE HAY RD
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1209
Practice Address - Country:US
Practice Address - Phone:515-727-8750
Practice Address - Fax:515-727-8757
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002109225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist