Provider Demographics
NPI:1457826208
Name:MOSHER, ELIZABETH (COTA/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MOSHER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:ROSIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 MAPLEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1524
Mailing Address - Country:US
Mailing Address - Phone:716-836-7200
Mailing Address - Fax:
Practice Address - Street 1:105 MAPLEVIEW RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1524
Practice Address - Country:US
Practice Address - Phone:716-836-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008775-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant