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Individual

IMMY MOUSTAFA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS, OTR/L

Contact information

Practice address
49 CLUB CT, STROUDSBURG, PA 18360-1547
(570) 807-8062
Mailing address
49 CLUB CT, STROUDSBURG, PA 18360-1547
(570) 807-8062

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00309300
NJ

Other

Enumeration date
05/04/2017
Last updated
05/04/2017
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