Provider Demographics
NPI:1407562036
Name:MOSS, MELISSA (COTA/L, MSOT/S)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:COTA/L, MSOT/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 LAVENDER CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3547
Mailing Address - Country:US
Mailing Address - Phone:920-216-8956
Mailing Address - Fax:
Practice Address - Street 1:4987 GOLDEN FOOTHILL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9364
Practice Address - Country:US
Practice Address - Phone:916-365-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3250224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant