Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 12699 | MA |
NPI | 1376001198 |
---|---|
Provider Name | Tyler Mosher |
First Address | Salem, NH 03079-4804 |
Second Address | Amesbury, MA 01913-2119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2019 |
Last Update Date | 11/03/2019 |