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NPI Code Detail

MEDICARE: CRYSTAL MOSS

MEDICARE: CRYSTAL MOSS
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
1225X00000XOccupational TherapistOT15766FL

General Provider Information

NPI Number : 1033554746
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL MOSS
Provider Business Mailing Address
First Line : 1955 N FEDERAL HWY UNIT 253
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33062-1036
Country : US
Telephone Number : 954-580-2520
Fax Number : 954-580-2521
Provider Business Practice Location Address
First Line : 1955 N FEDERAL HWY UNIT 253
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33062-1036
Country : US
Telephone Number : 954-580-2520
Fax Number : 954-580-2521
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2013
Last Update Date : 05/08/2013

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Directions to “ CRYSTAL MOSS ” Practice Location

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