Provider Demographics
NPI:1689051427
Name:MOOSSA, JOHN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MOOSSA
Suffix:
Gender:M
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 1:1521 CARLISLE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-1528
Mailing Address - Country:US
Mailing Address - Phone:804-615-2221
Mailing Address - Fax:
Practice Address - Street 1:1521 CARLISLE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-1528
Practice Address - Country:US
Practice Address - Phone:804-615-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006221225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist