Individual
MISS JACQUELINE DENISE MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 N EASTERN AVE STE 8EE, MOORE, OK 73160-5683
(802) 393-8007
Mailing address
2100 N EASTERN AVE STE 8, MOORE, OK 73160-5684
(802) 393-8007
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
—
—
224P00000X
Prosthetist
Primary
—
—
225000000X
Orthotic Fitter
—
—
Other
Enumeration date
04/29/2024
Last updated
04/29/2024
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