Provider Demographics
NPI:1740615590
Name:MOSS, CARISA (BS, MED)
Entity Type:Individual
Prefix:
First Name:CARISA
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:BS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:114 DOBY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-8748
Mailing Address - Country:US
Mailing Address - Phone:803-979-0300
Mailing Address - Fax:
Practice Address - Street 1:4301 N FEDERAL HIGHWAY
Practice Address - Street 2:SUITE 2 SOUTH BUTTERFLY EFFECTS, LLC
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:888-880-9270
Practice Address - Fax:954-342-0273
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist