Provider Demographics
NPI:1932857257
Name:PERKINS, MOLLY JEAN (OTR/L)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:JEAN
Last Name:PERKINS
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 1:3017 C ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2351
Mailing Address - Country:US
Mailing Address - Phone:760-208-5069
Mailing Address - Fax:
Practice Address - Street 1:2437 FENTON ST UNIT B
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3517
Practice Address - Country:US
Practice Address - Phone:619-656-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22460225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist