Provider Demographics
NPI:1053604272
Name:IKIUGU, MOSES NGUU (OTR)
Entity type:Individual
Prefix:PROF
First Name:MOSES
Middle Name:NGUU
Last Name:IKIUGU
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 E BLOOMINGDALE ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3071
Mailing Address - Country:US
Mailing Address - Phone:605-624-9352
Mailing Address - Fax:
Practice Address - Street 1:16 E BLOOMINGDALE ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-3071
Practice Address - Country:US
Practice Address - Phone:605-624-9352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0644225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist