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General NPI Number Information
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NPI Number | 1336062421
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Entity Type | Individual
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Provider Name | ISABELLA RENE MORENO OTD
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Gender | Female
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Dates
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Enumeration Date | 08/04/2026
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 124 MAIN ST
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City | CHARLESTOWN
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State | MA
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Zip | 02129-3544
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Country | US
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Telephone | 617-242-5159
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Fax |
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Provider Business Mailing Address
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Address Line | 24 LEXINGTON ST APT 3
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City | CHARLESTOWN
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State | MA
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Zip | 02129-3178
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Country | US
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Telephone | 631-255-3124
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTL36836
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License Number State | MA
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