MEDICARE: MELISSA 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
1	106S00000X	Behavior Technician	RBT-25-411500

General Provider Information

NPI Number	:	1790582070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MOORE

Provider Business Mailing Address
First Line	:	14405 SALEM RD
Second Line	:
City	:	EXCELSIOR SPRINGS
State	:	MO
Zip	:	64024-8400
Country	:	US
Telephone Number	:	816-585-1272
Fax Number	:	913-285-8134

Provider Business Practice Location Address
First Line	:	14405 SALEM RD
Second Line	:
City	:	EXCELSIOR SPRINGS
State	:	MO
Zip	:	64024-8400
Country	:	US
Telephone Number	:	816-585-1272
Fax Number	:	913-285-8134

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

Provider Enumeration Date	:	02/25/2025
Last Update Date	:	02/28/2025

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Directions to “ MELISSA MOORE ” Practice Location

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