=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245124882
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOVING MOUNTAIN OCCUPATIONAL THERAPY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2025
-----------------------------------------------------
Last Update Date | 06/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 N GALWAY DR
-----------------------------------------------------
City | GRANVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43023-9572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-501-3334
-----------------------------------------------------
Fax | 740-539-8823
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 793 FRANCIS DR
-----------------------------------------------------
City | HEATH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43056-1644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-501-3334
-----------------------------------------------------
Fax | 740-539-8823
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | MALLORY SPANGLER
-----------------------------------------------------
Credential | OTR/L, OTD
-----------------------------------------------------
Telephone | 740-501-3334
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------