MEDICARE: MRS. KERI BETH MOSLEY MOTR/L

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	112790	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APPLIED FOR	OTHER	MS	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861607525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KERI BETH MOSLEY MOTR/L

Provider Business Mailing Address
First Line	:	9653 CONSTELLATION BLVD
Second Line	:	APT 11210
City	:	FORT WORTH
State	:	TX
Zip	:	76108-7648
Country	:	US
Telephone Number	:	662-719-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	9653 CONSTELLATION BLVD
Second Line	:	APT 11210
City	:	FORT WORTH
State	:	TX
Zip	:	76108-7648
Country	:	US
Telephone Number	:	662-719-3774
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	04/17/2009

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