Active NPI
Molly Rose Stark, OTR/L
- Occupational Therapist
- San Rafael, CA
National Provider Identifier
1346854908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT21162
- Practice address
- 234 N San Pedro Rd
San Rafael, CA 94903-2858 - Phone
- (415) 479-3450
- NPI assigned
- Sep 1, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT21162 | CA | Primary |
Addresses
Primary practice location
234 N San Pedro Rd
San Rafael, CA 94903-2858
Mailing address
7630 Geary Blvd Apt 105
San Francisco, CA 94121-1555
Phone (339) 225-1614
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT21162 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598918400000",
"number": "1346854908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7630 GEARY BLVD APT 105",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941211555",
"telephone_number": "339-225-1614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "234 N SAN PEDRO RD",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949032858",
"telephone_number": "415-479-3450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "MOLLY",
"middle_name": "ROSE",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-01",
"last_updated": "2020-09-01",
"certification_date": "2020-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "OT21162",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.