Individual
REBECCA MOOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
490 HIGHWAY 96 W, SHOREVIEW, MN 55126-1960
(651) 415-5490
Mailing address
5801 PORTLAND AVE, WHITE BEAR LAKE, MN 55110-5728
(651) 587-5689
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
105571
MN
Other
Enumeration date
01/24/2018
Last updated
01/24/2018
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