=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962907105
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOIRA SEONA MAUS OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2018
-----------------------------------------------------
Last Update Date | 12/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | NAVAL MEDICAL CENTER 100 BREWSTER BLVD
-----------------------------------------------------
City | CAMP LEJEUNE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28547-2538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-449-1154
-----------------------------------------------------
Fax | 989-739-0257
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 188 BRIDLEWOOD DR
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28540-9101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-619-1027
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 5201008480
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------