Provider Demographics
NPI:1992255913
Name:HOISINGTON, MOLLY ANSEL (OTR/L)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANSEL
Last Name:HOISINGTON
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 1:2501 PRAIRIE AVE
Mailing Address - Street 2:#3G
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2270
Mailing Address - Country:US
Mailing Address - Phone:773-272-5345
Mailing Address - Fax:
Practice Address - Street 1:605 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2420
Practice Address - Country:US
Practice Address - Phone:847-480-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.011653225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist