Provider Demographics
NPI:1699159152
Name:BENNETT, MOLLY RAE (OTR/L)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:RAE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 AMES HILL DR
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1174
Mailing Address - Country:US
Mailing Address - Phone:732-859-6288
Mailing Address - Fax:
Practice Address - Street 1:275 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5404
Practice Address - Country:US
Practice Address - Phone:978-744-7037
Practice Address - Fax:978-741-8175
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11652225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics