Organization
MOSS OCCUPATIONAL THERAPY SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACY LYNN LIN (OCCUPATIONAL THERAPIST)
(404) 957-5015
Entity
Organization
Contact information
Practice address
2508 BROOKGATE WAY, ELLENWOOD, GA 30294-2390
(404) 957-5015
Mailing address
4093 VILLAGEWOOD LN, ELLENWOOD, GA 30294-5721
(404) 957-5015
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT005980
GA
225XP0019X
Physical Rehabilitation Occupational Therapist
OT005980
GA
Other
Enumeration date
08/22/2017
Last updated
09/12/2024
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