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General NPI Number Information
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NPI Number | 1679209852
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Entity Type | Organization
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Legal Business Name | FULL MOON PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 1511 CARTER ST
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City | RICHMOND
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State | VA
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Zip | 23220-6903
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Country | US
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Telephone | 804-965-3797
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Fax |
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Provider Business Mailing Address
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Address Line | 1511 CARTER ST
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City | RICHMOND
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State | VA
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Zip | 23220-6903
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Country | US
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Telephone | 804-965-3797
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VESNEEK DHANI
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Credential | OTR/L
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Telephone | 804-965-3797
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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 |
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License Number State |
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