Provider Demographics
NPI:1962907105
Name:MAUS, MOIRA SEONA (OTR)
Entity type:Individual
Prefix:
First Name:MOIRA
Middle Name:SEONA
Last Name:MAUS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7173
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-2173
Mailing Address - Country:US
Mailing Address - Phone:989-619-1027
Mailing Address - Fax:
Practice Address - Street 1:NAVAL MEDICAL CENTER
Practice Address - Street 2:100 BREWSTER BLVD
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2538
Practice Address - Country:US
Practice Address - Phone:910-449-1154
Practice Address - Fax:989-739-0257
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008480225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty