Healthcare Provider Details

I. General information

NPI: 1528975224
Provider Name (Legal Business Name): KAISHA ALEXUS MOORE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MEDICAL PARK DR STE 202A
CONCORD NC
28025-3059
US

IV. Provider business mailing address

2121 KUMARA RD APT 204
CHARLOTTE NC
28262-0309
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-2627
  • Fax:
Mailing address:
  • Phone: 704-403-2627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18620
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number18620
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: