Provider Demographics
NPI:1639370471
Name:MOSES, JOANNA MARIE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:MARIE
Last Name:MOSES
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MISS
Other - First Name:JOANNA
Other - Middle Name:MARIE
Other - Last Name:SLONIECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:1107 MOUNT PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-4960
Mailing Address - Country:US
Mailing Address - Phone:774-202-4900
Mailing Address - Fax:
Practice Address - Street 1:273 OAK GROVE AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-2315
Practice Address - Country:US
Practice Address - Phone:774-202-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8752225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist