Basic Information
| Provider Information | |||||||||
| NPI: | 1134403694 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MOLLY BUIST & ASSOCIATES INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE CENTER FOR CHILDHOOD DEVELOPMENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7086 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | JENISON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494289352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166679551 | ||||||||
| FaxNumber: | 6166679552 | ||||||||
| Practice Location | |||||||||
| Address1: | 7086 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | JENISON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494289352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166679551 | ||||||||
| FaxNumber: | 6166678552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2011 | ||||||||
| LastUpdateDate: | 12/03/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BUIST | ||||||||
| AuthorizedOfficialFirstName: | MOLLY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6166679551 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5201007232 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 5201000987 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | 09130441 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 12005914 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225X00000X | 5201001977 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.