Healthcare Provider Details

I. General information

NPI: 1932021607
Provider Name (Legal Business Name): GRACE HELEN MOELLER OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 12TH ST
LOCKWOOD MO
65682-8337
US

IV. Provider business mailing address

2891 LAWRENCE 1120
MILLER MO
65707-8114
US

V. Phone/Fax

Practice location:
  • Phone: 417-232-4571
  • Fax:
Mailing address:
  • Phone: 633-515-7574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2026033835
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: