Healthcare Provider Details

I. General information

NPI: 1730776626
Provider Name (Legal Business Name): MOXIE OT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2020
Last Update Date: 12/24/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 W MELROSE ST
CHICAGO IL
60618-5414
US

IV. Provider business mailing address

3433 W MELROSE ST
CHICAGO IL
60618-5414
US

V. Phone/Fax

Practice location:
  • Phone: 559-273-1238
  • Fax:
Mailing address:
  • Phone: 559-273-1238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SARAH M ZERA
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTD, OTR/L
Phone: 559-273-1238