Kayla Marie Moberg, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

006979 Issued in AZ

Practice address

1830 S Alma School Rd Ste 122
Mesa, AZ 85210-3087

Phone

(480) 855-0474

NPI assigned

May 11, 2022

Last updated

May 11, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652227200000",
    "number": "1205572211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 W GERMANN RD APT 2144",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852867280",
            "telephone_number": "925-819-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 S ALMA SCHOOL RD STE 122",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852103087",
            "telephone_number": "480-855-0474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOBERG",
        "first_name": "KAYLA",
        "middle_name": "MARIE",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-11",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "AZ",
            "license": "006979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa Mitchell
• Nicole Mitten, FNP-C
• Candace Miyatani, BHT, BS, MA
• MJW Ventures (Serenity Residential Services)
• Mo Medtrans, LLC
• Mobile Dentistry of Az, LLC
• Mobile Medical Providers of Arizona, LLC
• Mobilecaremd LLC
• Modern Ambulatory Surgery Center, PC
• Modern Dental Professionals - Arizona PC (Brightnow Mesa Country Club Dr)

• Occupational Therapy Assistant in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Occupational Therapy Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.