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General NPI Number Information
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NPI Number | 1336005206
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Entity Type | Individual
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Provider Name | CARLY CHRISTINE MOUSHEGIAN COTA/L
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Gender | Female
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 815 S VASSAULT ST
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City | TACOMA
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State | WA
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Zip | 98465-2008
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Country | US
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Telephone | 253-444-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 12320 108TH AVENUE CT E
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City | PUYALLUP
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State | WA
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Zip | 98374-2725
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Country | US
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Telephone | 253-389-5776
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OC70033060
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License Number State | WA
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