Individual
KYRA LEE MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LOTR
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
Update your record
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