MEDICARE: DEANN EVELYN MOSER-JENS OTR/L

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	225XP0200X	Pediatric Occupational Therapist	5883	NC

General Provider Information

NPI Number	:	1427237072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANN EVELYN MOSER-JENS OTR/L

Provider Business Mailing Address
First Line	:	7209 CREEDMOOR RD STE 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-1695
Country	:	US
Telephone Number	:	919-844-1100
Fax Number	:	919-844-1102

Provider Business Practice Location Address
First Line	:	7209 CREEDMOOR RD STE 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-1695
Country	:	US
Telephone Number	:	919-844-1100
Fax Number	:	919-844-1102

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

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	10/31/2007

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