Provider Demographics
NPI:1902944952
Name:PIEKUT, MOLLY (OT)
Entity Type:Individual
Prefix:MISS
First Name:MOLLY
Middle Name:
Last Name:PIEKUT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2826
Mailing Address - Country:US
Mailing Address - Phone:516-885-2336
Mailing Address - Fax:631-284-3982
Practice Address - Street 1:58 ROSE AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2826
Practice Address - Country:US
Practice Address - Phone:516-885-2336
Practice Address - Fax:631-284-3982
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011252-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ1234ZTXR1Medicare PIN