Provider Demographics
NPI:1972625754
Name:MOSER, GEORGIA JEAN (COTA-L)
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:JEAN
Last Name:MOSER
Suffix:
Gender:F
Credentials:COTA-L
Other - Prefix:MRS
Other - First Name:GEORGIA
Other - Middle Name:JEAN
Other - Last Name:NORGORVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA-L
Mailing Address - Street 1:100 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1725
Mailing Address - Country:US
Mailing Address - Phone:440-891-9837
Mailing Address - Fax:
Practice Address - Street 1:255 FRONT ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1943
Practice Address - Country:US
Practice Address - Phone:440-253-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA 00651224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant