Provider Demographics
NPI:1003502550
Name:MOSIER, KATHERINE MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MICHELLE
Last Name:MOSIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21750 RED RUM DR STE 117
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5867
Mailing Address - Country:US
Mailing Address - Phone:703-571-2989
Mailing Address - Fax:
Practice Address - Street 1:21750 RED RUM DR STE 117
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5867
Practice Address - Country:US
Practice Address - Phone:703-574-2989
Practice Address - Fax:703-571-2941
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002568224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant