MEDICARE: SUSAN MOORE MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2117	NH

General Provider Information

NPI Number	:	1265169080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MOORE MS, OTR/L

Provider Business Mailing Address
First Line	:	26 HARDING RD
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-5834
Country	:	US
Telephone Number	:	603-969-8712
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 VAN BUREN AVE
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-5830
Country	:	US
Telephone Number	:	603-436-2231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	08/02/2022

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