Provider Demographics
NPI:1427689470
Name:MAULDIN, MOLLY COUICK
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:COUICK
Last Name:MAULDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 CLARENCE SECREST RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-8051
Mailing Address - Country:US
Mailing Address - Phone:704-681-1452
Mailing Address - Fax:
Practice Address - Street 1:2814 GRAY FOX RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-8422
Practice Address - Country:US
Practice Address - Phone:704-821-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12949225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist