1215374814 NPI number — DENISE MOELLER MS, OTR/L

Table of content: DENISE MOELLER MS, OTR/L (NPI 1215374814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215374814 NPI number — DENISE MOELLER MS, OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOELLER
Provider First Name:
DENISE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
END
Provider Other First Name:
DENISE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215374814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6165 FULLER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22310-2541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-720-2261
Provider Business Mailing Address Fax Number:
540-720-5660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2765 JEFFERSON DAVIS HWY
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
STAFFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22554-8331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-720-2261
Provider Business Practice Location Address Fax Number:
540-720-5660
Provider Enumeration Date:
05/23/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  01196000211 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)