Basic Information
| Provider Information | |||||||||
| NPI: | 1083175814 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MUNOZ | ||||||||
| FirstName: | MORIAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 FCR 430 | ||||||||
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| City: | BUFFALO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 758316842 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 420 MOODY ST | ||||||||
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| City: | FAIRFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 758403036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033891236 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2019 | ||||||||
| LastUpdateDate: | 03/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 214324 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.