Healthcare Provider Details

I. General information

NPI: 1467908723
Provider Name (Legal Business Name): KRISTEN JENETTA MOORE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33122 VALLE RD
SAN JUAN CAPISTRANO CA
92675-4853
US

IV. Provider business mailing address

50 LA SORDINA
RANCHO SANTA MARGARITA CA
92688-3217
US

V. Phone/Fax

Practice location:
  • Phone: 949-234-9200
  • Fax:
Mailing address:
  • Phone: 562-324-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number16467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: