Provider Demographics
NPI:1790161883
Name:MOSELEY, ROCHELLE (MS)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 E BROADWAY ST #122
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8597
Mailing Address - Country:US
Mailing Address - Phone:407-359-5693
Mailing Address - Fax:407-792-5693
Practice Address - Street 1:2625 BARNA AVE STE H
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-3417
Practice Address - Country:US
Practice Address - Phone:321-362-4099
Practice Address - Fax:321-348-5750
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015929300Medicaid