Provider Demographics
NPI:1487307575
Name:MOSBACHER, MARLENA IISHA (OTR/L)
Entity type:Individual
Prefix:
First Name:MARLENA
Middle Name:IISHA
Last Name:MOSBACHER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 KENSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2734
Mailing Address - Country:US
Mailing Address - Phone:740-502-4418
Mailing Address - Fax:
Practice Address - Street 1:9940 W UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-1673
Practice Address - Country:US
Practice Address - Phone:623-933-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-007641225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist