Provider Demographics
NPI:1992060008
Name:MOSS, DEBORAH R (RN, OTL)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:R
Last Name:MOSS
Suffix:
Gender:F
Credentials:RN, OTL
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:R
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT, RN
Mailing Address - Street 1:1201 SHAFFER RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-5761
Mailing Address - Country:US
Mailing Address - Phone:831-466-9307
Mailing Address - Fax:831-466-9748
Practice Address - Street 1:1201 SHAFFER RD BLDG 1
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-5761
Practice Address - Country:US
Practice Address - Phone:831-466-9307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13456225XM0800X, 225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC5970197OtherDRIVER LICENSE