MEDICARE: KATHERINE MOOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	122300	TX

General Provider Information

NPI Number	:	1003568916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MOOS

Provider Business Mailing Address
First Line	:	5300 ALTAMESA BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5924
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 ALTAMESA BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5924
Country	:	US
Telephone Number	:	817-346-1800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2022
Last Update Date	:	01/21/2022

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Directions to “ KATHERINE MOOS ” Practice Location

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