Individual
MOLLIE WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD
Contact information
Practice address
304 NE HOOD AVE, GRESHAM, OR 97030-7450
(503) 666-1333
(503) 666-2444
Mailing address
304 NE HOOD AVE, GRESHAM, OR 97030-7450
(503) 666-1333
(503) 666-2444
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
444015
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
444015
STATE LICENSE
OR
Enumeration date
10/14/2020
Last updated
10/14/2020
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