Provider Demographics
NPI:1508461260
Name:MOSER, HANNAH ALEXIS (OTR/L)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:ALEXIS
Last Name:MOSER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-5257
Mailing Address - Country:US
Mailing Address - Phone:704-775-4466
Mailing Address - Fax:704-775-4466
Practice Address - Street 1:125 W BROAD ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5257
Practice Address - Country:US
Practice Address - Phone:704-775-4466
Practice Address - Fax:704-775-4466
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12938225X00000X
NC13732225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1578977179Medicaid