Healthcare Provider Details

I. General information

NPI: 1639095698
Provider Name (Legal Business Name): MARIAH JADE MOSER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S 100 E STE 2B
ST GEORGE UT
84770-3469
US

IV. Provider business mailing address

2271 E DINOSAUR CROSSING DR APT D404
ST GEORGE UT
84790-1653
US

V. Phone/Fax

Practice location:
  • Phone: 435-200-4968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14283331-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: