Provider Demographics
NPI:1659303147
Name:MOON, LINDA D (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:D
Last Name:MOON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 NAUTICAL CT
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32409-4827
Mailing Address - Country:US
Mailing Address - Phone:850-628-0981
Mailing Address - Fax:850-786-3638
Practice Address - Street 1:7514 NAUTICAL CT
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32409-4827
Practice Address - Country:US
Practice Address - Phone:850-628-0981
Practice Address - Fax:850-786-3638
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XF0002X
FLOT 10128225XL0004X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00303830OtherRR MEDICARE
FL116506000Medicaid
FL890835400Medicaid