Individual
KYRA LEE MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LOTR
Contact information
Practice address
2335 CHURCH ST, STE G, ZACHARY, LA 70791-2700
(225) 654-8208
(225) 654-4642
Mailing address
2335 CHURCH ST, STE G, ZACHARY, LA 70791-2700
(225) 654-8208
(225) 654-4642
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTT.Z11046
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1025071
—
LA
01
—
4B790C943
MEDICARE
LA
Enumeration date
05/31/2007
Last updated
01/16/2008
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