Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1437316973 |
---|---|
Provider Name | Mary Moser |
First Address | Kansas City, MO 64111-5961 |
Second Address | Kansas City, MO 64111-5961 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 21/05/2008 |