Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 122300 | TX |
NPI | 1003568916 |
---|---|
Provider Name | Katherine Moos |
First Address | Fort Worth, TX 76133-5924 |
Second Address | Fort Worth, TX 76133-5924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2022 |
Last Update Date | 21/01/2022 |