Provider Demographics
NPI:1891067062
Name:MOSHER, DEBORAH (COTA)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:MOSHER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 QUAIL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077-4426
Mailing Address - Country:US
Mailing Address - Phone:518-426-0711
Mailing Address - Fax:
Practice Address - Street 1:30 SOUTHGATE RD
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1132
Practice Address - Country:US
Practice Address - Phone:518-785-6607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002145224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY224Z00000XOtherOCCUPATIONAL THERAPY ASSISTANT