Provider Demographics
NPI:1659303147
Name:MOON, LINDA D (OTR)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:D
Last Name:MOON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 NAUTICAL CT
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32409-4827
Mailing Address - Country:US
Mailing Address - Phone:850-628-0981
Mailing Address - Fax:850-786-3638
Practice Address - Street 1:7514 NAUTICAL CT
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32409-4827
Practice Address - Country:US
Practice Address - Phone:850-628-0981
Practice Address - Fax:850-786-3638
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLOT 10128225XL0004X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116506000Medicaid
FLP00303830OtherRR MEDICARE
FL890835400Medicaid