Healthcare Provider Details

I. General information

NPI: 1780051953
Provider Name (Legal Business Name): JACLYN M MOYER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 QUAIL DR
GILBERTSVILLE PA
19525-8915
US

IV. Provider business mailing address

208 QUAIL DR
GILBERTSVILLE PA
19525-8915
US

V. Phone/Fax

Practice location:
  • Phone: 484-269-3531
  • Fax:
Mailing address:
  • Phone: 484-269-3531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC012174
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOC012174
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: