MEDICARE: MS. LANIKA SHANTEL MOSLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	2007012791	MO
2	224Z00000X	Occupational Therapy Assistant	1669	CA

General Provider Information

NPI Number	:	1194998880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LANIKA SHANTEL MOSLEY

Provider Business Mailing Address
First Line	:	1410 AVON PARK DR APT 4
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48503-7203
Country	:	US
Telephone Number	:	810-210-2758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1410 AVON PARK DR APT 7
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48503-7203
Country	:	US
Telephone Number	:	810-210-2758
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2008
Last Update Date	:	08/29/2010

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