MEDICARE: DEBORAH R MOSS RN, OTL

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	225XM0800X	Mental Health Occupational Therapist	13456	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C5970197	OTHER	CA	DRIVER LICENSE

General Provider Information

NPI Number	:	1992060008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH R MOSS RN, OTL

Provider Business Mailing Address
First Line	:	1201 SHAFFER RD BLDG 1
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-5761
Country	:	US
Telephone Number	:	831-466-9307
Fax Number	:	831-466-9748

Provider Business Practice Location Address
First Line	:	1201 SHAFFER RD BLDG 1
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-5761
Country	:	US
Telephone Number	:	831-466-9307
Fax Number	:

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

Provider Enumeration Date	:	07/05/2012
Last Update Date	:	01/08/2025

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