Provider Demographics
NPI:1225655459
Name:MOSS, FRANK (COTA)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:MOSS
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 BELLBROOK ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1103
Mailing Address - Country:US
Mailing Address - Phone:240-346-8512
Mailing Address - Fax:
Practice Address - Street 1:2703 BELLBROOK ST
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1103
Practice Address - Country:US
Practice Address - Phone:240-346-8512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-04
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC100000345224Z00000X
MDA02728224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant