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General NPI Number Information
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NPI Number | 1477223972
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Entity Type | Individual
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Provider Name | TAYLOR RENE MOSS
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Gender | Female
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 4141 S BRAESWOOD BLVD
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City | HOUSTON
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State | TX
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Zip | 77025-3307
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Country | US
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Telephone | 713-666-2651
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Fax |
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Provider Business Mailing Address
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Address Line | 195 N CREEK DR APT 1206
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City | SUMMERVILLE
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State | SC
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Zip | 29486-5344
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Country | US
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Telephone | 915-352-0402
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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 | 217075
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License Number State | TX
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