Individual
MS. JESSICA M MOULE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR-L
Contact information
Practice address
11628 SW 50TH CT, COOPER CITY, FL 33330-4414
(305) 335-3263
Mailing address
11628 SW 50TH CT, COOPER CITY, FL 33330-4414
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
OT12225
FL
225X00000X
Occupational Therapist
Primary
OT12225
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891592000
—
FL
Enumeration date
11/24/2006
Last updated
08/29/2012
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