Individual
MISS MARY MOULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2515 14TH AVE, GREELEY, CO 80631-8316
(815) 441-7910
Mailing address
2515 14TH AVE, GREELEY, CO 80631-8316
(815) 441-7910
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
280551
CO
Other
Enumeration date
02/22/2011
Last updated
02/22/2011
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