Provider Demographics
NPI:1962150821
Name:HOUDESHELL, MOLLY JOSEPHINE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:JOSEPHINE
Last Name:HOUDESHELL
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 1:2075 350TH ST
Mailing Address - Street 2:
Mailing Address - City:STANHOPE
Mailing Address - State:IA
Mailing Address - Zip Code:50246-7516
Mailing Address - Country:US
Mailing Address - Phone:515-310-0460
Mailing Address - Fax:
Practice Address - Street 1:950 OFFICE PARK RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2548
Practice Address - Country:US
Practice Address - Phone:515-224-0979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA112975225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist