Provider Demographics
NPI:1366976359
Name:TRUDT, MOLLY ELIZABETH COOK
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ELIZABETH COOK
Last Name:TRUDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:68 HERITAGE HL
Mailing Address - Street 2:
Mailing Address - City:ORAN
Mailing Address - State:MO
Mailing Address - Zip Code:63771-8708
Mailing Address - Country:US
Mailing Address - Phone:573-318-6105
Mailing Address - Fax:
Practice Address - Street 1:10300 INDIAN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2484
Practice Address - Country:US
Practice Address - Phone:913-232-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD369A224Z00000X
MO2016030530224Z00000X
KS17-03878225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant