Provider Demographics
NPI:1538040910
Name:MINABERRY, MOLLY
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MINABERRY
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 1:17615 85TH AVENUE CT E STE C
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-1902
Mailing Address - Country:US
Mailing Address - Phone:253-216-2589
Mailing Address - Fax:
Practice Address - Street 1:17615 85TH AVENUE CT E STE C
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-1902
Practice Address - Country:US
Practice Address - Phone:253-216-2589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT.OT.70016743225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist