Provider Demographics
NPI:1528022316
Name:ROSENTHAL-MOSKOW, AMY (OT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ROSENTHAL-MOSKOW
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:MOSKOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:2 BALA PLAZA
Mailing Address - Street 2:SUITE IL-47
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004
Mailing Address - Country:US
Mailing Address - Phone:610-668-1048
Mailing Address - Fax:610-668-9539
Practice Address - Street 1:2 BALA PLAZA
Practice Address - Street 2:SUITE IL-47
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004
Practice Address - Country:US
Practice Address - Phone:610-668-1048
Practice Address - Fax:610-668-9539
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA002018L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA068125Medicare ID - Type Unspecified