Healthcare Provider Details

I. General information

NPI: 1336891324
Provider Name (Legal Business Name): KATHLEEN MOORE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 05/30/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3232 CENTRAL PARK W
TOLEDO OH
43617-3010
US

IV. Provider business mailing address

3232 CENTRAL PARK W
TOLEDO OH
43617-3010
US

V. Phone/Fax

Practice location:
  • Phone: 800-653-4077
  • Fax:
Mailing address:
  • Phone: 800-653-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-80699
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-200657
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: