Provider Demographics
NPI:1639534514
Name:MOSS, CAROL PATZWAHL (ATC)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:PATZWAHL
Last Name:MOSS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:906 OKEEFE RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1354
Mailing Address - Country:US
Mailing Address - Phone:269-274-3960
Mailing Address - Fax:517-629-0938
Practice Address - Street 1:906 OKEEFE RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1354
Practice Address - Country:US
Practice Address - Phone:269-274-3960
Practice Address - Fax:517-629-0938
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI36529452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer