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NPI Code Detail

MEDICARE: ANNETTE MOORE

MEDICARE: ANNETTE MOORE
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
1224Z00000XOccupational Therapy Assistant01286OH

General Provider Information

NPI Number : 1619216165
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNETTE MOORE
Provider Business Mailing Address
First Line : 1235 SARASUE AVE
Second Line :
City : PORTSMOUTH
State : OH
Zip : 45662-6445
Country : US
Telephone Number : 740-353-5147
Fax Number :
Provider Business Practice Location Address
First Line : 10098 BEAR CREEK RD
Second Line :
City : LUCASVILLE
State : OH
Zip : 45648-9168
Country : US
Telephone Number : 740-259-5536
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2013
Last Update Date : 02/04/2013

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Directions to “ ANNETTE MOORE ” Practice Location

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