Healthcare Provider Details

I. General information

NPI: 1184443061
Provider Name (Legal Business Name): ANGELA CHILTON MOORE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA GAIL CHILTON OTR/L

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 S LIBERTY ST
WINSTON SALEM NC
27101-5260
US

IV. Provider business mailing address

1025 TREVOR DOWNS CT
LEWISVILLE NC
27023-9697
US

V. Phone/Fax

Practice location:
  • Phone: 336-934-4058
  • Fax: 743-255-3010
Mailing address:
  • Phone: 336-970-9697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7366
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: