MEDICARE: MRS. LISA ANN MOX C.O.T.A.

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	224Z00000X	Occupational Therapy Assistant	A00522	MD

General Provider Information

NPI Number	:	1649492661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA ANN MOX C.O.T.A.

Provider Business Mailing Address
First Line	:	5836 OAKLAND RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21227-4328
Country	:	US
Telephone Number	:	410-242-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	5836 OAKLAND RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21227-4328
Country	:	US
Telephone Number	:	410-242-0550
Fax Number	:

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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