Active NPI
Melissa Moose, OT
- Occupational Therapist
- Winston Salem, NC
National Provider Identifier
1205950490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4791
- Practice address
- 2500 Polo Ridge CT
Winston Salem, NC 27106-3950 - Phone
- (336) 734-1734
- Fax
- (336) 723-7828
- NPI assigned
- Mar 16, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 4791 | NC | Primary |
Addresses
Primary practice location
2500 Polo Ridge CT
Winston Salem, NC 27106-3950
Mailing address
174 Scott Rd
Lewisville, NC 27023-8168
Phone (336) 734-1734
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4791 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205950490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "174 SCOTT RD",
"city": "LEWISVILLE",
"state": "NC",
"postal_code": "270238168",
"telephone_number": "336-734-1734",
"fax_number": "336-723-7828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 POLO RIDGE CT",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271063950",
"telephone_number": "336-734-1734",
"fax_number": "336-723-7828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOOSE",
"first_name": "MELISSA",
"credential": "OT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "4791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.