Basic Information
| Provider Information | |||||||||
| NPI: | 1073752721 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSLEY | ||||||||
| FirstName: | ROBERT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 WELLS CT | ||||||||
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| City: | CANTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390467005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019270282 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3690 SOUTHWESTERN BLVD | ||||||||
| Address2: | |||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141271720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166624955 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2009 | ||||||||
| LastUpdateDate: | 01/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.