Provider Demographics
NPI:1083664791
Name:MOITOSO, VICTORIA E (OTRL)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:E
Last Name:MOITOSO
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:100 SMITHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3497
Mailing Address - Country:US
Mailing Address - Phone:401-725-9666
Mailing Address - Fax:401-722-5896
Practice Address - Street 1:100 SMITHFIELD AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3497
Practice Address - Country:US
Practice Address - Phone:401-725-9666
Practice Address - Fax:401-722-5896
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT00777225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI412614OtherBLUECHIP RI IND. ID #
RI007057840Medicare ID - Type UnspecifiedMEDICARE RI IND. ID#