Provider Demographics
NPI:1285094441
Name:MOMENI, ROXANNA
Entity type:Individual
Prefix:
First Name:ROXANNA
Middle Name:
Last Name:MOMENI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 N HEMMER RD
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-9604
Mailing Address - Country:US
Mailing Address - Phone:907-887-1697
Mailing Address - Fax:888-919-1403
Practice Address - Street 1:2020 N HEMMER RD
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9604
Practice Address - Country:US
Practice Address - Phone:907-887-1697
Practice Address - Fax:888-919-1403
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK124368225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist