Healthcare Provider Details

I. General information

NPI: 1366999328
Provider Name (Legal Business Name): TAMICA MARIE MOSLEY MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMICA WOODARD

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9368 N LILLEY RD
PLYMOUTH MI
48170-4610
US

IV. Provider business mailing address

9368 N LILLEY RD
PLYMOUTH MI
48170-4610
US

V. Phone/Fax

Practice location:
  • Phone: 734-416-3900
  • Fax: 734-453-2118
Mailing address:
  • Phone: 734-416-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201007436
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: