Individual
LYDIA TANNIS MOSHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT/L
Contact information
Practice address
90 HOWARD DR, SHELBYVILLE, KY 40065-8138
(502) 633-1007
Mailing address
90 HOWARD DRIVE, SHELBYVILLE, KY 40065
(502) 633-1007
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
KY-R5866
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100308850
—
KY
Enumeration date
06/11/2014
Last updated
09/07/2017
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