Provider Demographics
NPI:1982357984
Name:MOSER, KATHLEEN COLY (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:COLY
Last Name:MOSER
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 SW 48TH TER
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-8287
Mailing Address - Country:US
Mailing Address - Phone:954-708-5857
Mailing Address - Fax:
Practice Address - Street 1:950 GLADES ROAD
Practice Address - Street 2:#200
Practice Address - City:BOCA
Practice Address - State:FL
Practice Address - Zip Code:33441
Practice Address - Country:US
Practice Address - Phone:954-708-5857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA11715224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant