Provider Demographics
NPI:1932634193
Name:MOISE, LOVELY
Entity Type:Individual
Prefix:
First Name:LOVELY
Middle Name:
Last Name:MOISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 TUDOR WAY APT 207
Mailing Address - Street 2:APT 207
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-7077
Mailing Address - Country:US
Mailing Address - Phone:954-394-4132
Mailing Address - Fax:
Practice Address - Street 1:6100 TUDOR WAY APT 207
Practice Address - Street 2:APT 207
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-7077
Practice Address - Country:US
Practice Address - Phone:954-394-4132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA3298224Z00000X
FLOTA 14414224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant