An update to this issue. While the same account was being used, there were two mailboxes created, one on-prem and the other in O365. Found this article: https://learn.microsoft.com/en-us/exchange/troubleshoot/user-and-shared-mailboxes/mailbox-exists-exo-onpremises?WT.mc_id=365AdminCSH_SupportCentral
The article focused on saving the O365 mailbox, while I needed to save the on-prem mailbox. The solution was to remove the user's O365 license in AAD. The Office 365 mailbox was deleted automatically and mail flow was returned to normal.
HTH anyone with this issue.