Provider Demographics
NPI:1548555675
Name:BAGBY, MOLLY ANNE SHIELDS (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:ANNE SHIELDS
Last Name:BAGBY
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 1:1303 PROFESSOR PL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5910
Mailing Address - Country:US
Mailing Address - Phone:412-901-1981
Mailing Address - Fax:
Practice Address - Street 1:1303 PROFESSOR PL
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5910
Practice Address - Country:US
Practice Address - Phone:412-901-1981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7328225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist