MEDICARE: GRISEL DE LA CONCEPCION MOZAS MSOT

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	OT19516	FL

General Provider Information

NPI Number	:	1487137048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRISEL DE LA CONCEPCION MOZAS MSOT

Provider Business Mailing Address
First Line	:	12786 NW 102ND PL
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-6028
Country	:	US
Telephone Number	:	305-303-5632
Fax Number	:

Provider Business Practice Location Address
First Line	:	12786 NW 102ND PL
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-6028
Country	:	US
Telephone Number	:	305-303-5632
Fax Number	:

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

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	09/10/2018

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Directions to “ GRISEL DE LA CONCEPCION MOZAS MSOT” Practice Location

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