Healthcare Provider Details

I. General information

NPI: 1659303147
Provider Name (Legal Business Name): LINDA D MOON O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7514 NAUTICAL CT
PANAMA CITY FL
32409-4827
US

IV. Provider business mailing address

7514 NAUTICAL CT
PANAMA CITY FL
32409-4827
US

V. Phone/Fax

Practice location:
  • Phone: 850-628-0981
  • Fax: 850-786-3638
Mailing address:
  • Phone: 850-628-0981
  • Fax: 850-786-3638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License NumberOT 10128
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 10128
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: