Healthcare Provider Details

I. General information

NPI: 1154079150
Provider Name (Legal Business Name): EMMA MAE MOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 VAN REED RD
WYOMISSING PA
19610-1799
US

IV. Provider business mailing address

MISSION AUTISM CLINICS 9 BANKS AVENUE
MCADOO PA
18237-2508
US

V. Phone/Fax

Practice location:
  • Phone: 888-726-4774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: