Provider Demographics
NPI:1003787359
Name:MURDOCK, MOLLIE ELIZABETH (COTA/L)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:ELIZABETH
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 106TH ST
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:IL
Mailing Address - Zip Code:61462-9145
Mailing Address - Country:US
Mailing Address - Phone:309-363-7594
Mailing Address - Fax:309-966-3621
Practice Address - Street 1:4450 N PROSPECT RD STE C5
Practice Address - Street 2:
Practice Address - City:PEORIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:61616-6578
Practice Address - Country:US
Practice Address - Phone:309-363-7594
Practice Address - Fax:309-966-3621
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057006256224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant