Provider Demographics
NPI:1497195507
Name:VARON, MOLLY RAE (OTR/L)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:RAE
Last Name:VARON
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 1:210 TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1774
Mailing Address - Country:US
Mailing Address - Phone:248-643-8900
Mailing Address - Fax:
Practice Address - Street 1:33200 W 14 MILE RD
Practice Address - Street 2:STE 160
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3563
Practice Address - Country:US
Practice Address - Phone:248-538-7607
Practice Address - Fax:248-538-7623
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008814225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist