MEDICARE: MRS. LINDA D MOON O.T.R.

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	222Q00000X	Developmental Therapist
2	225XL0004X	Low Vision Occupational Therapist	OT 10128	FL
3	225X00000X	Occupational Therapist	OT 10128	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00303830	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659303147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA D MOON O.T.R.

Provider Business Mailing Address
First Line	:	7514 NAUTICAL CT
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32409-4827
Country	:	US
Telephone Number	:	850-628-0981
Fax Number	:	850-786-3638

Provider Business Practice Location Address
First Line	:	7514 NAUTICAL CT
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32409-4827
Country	:	US
Telephone Number	:	850-628-0981
Fax Number	:	850-786-3638

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	05/24/2024

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Directions to “ MRS. LINDA D MOON O.T.R.” Practice Location

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