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General NPI Number Information
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NPI Number | 1902072051
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Entity Type | Individual
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Provider Name | ELIZABETH CAROLYN MOON OTR
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Gender | Female
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 8050 MEADOW RD
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City | DALLAS
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State | TX
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Zip | 75231-3406
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Country | US
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Telephone | 469-232-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 411 MAYRANT DR
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City | DALLAS
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State | TX
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Zip | 75224-1419
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Country | US
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Telephone | 214-876-2804
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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 | 109677
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License Number State | TX
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