Healthcare Provider Details

I. General information

NPI: 1972293983
Provider Name (Legal Business Name): ELIZABETH MOORE MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 FRANKLIN RD
LOOKOUT MOUNTAIN TN
37350-1224
US

IV. Provider business mailing address

PO BOX 4362
CHATTANOOGA TN
37405-0362
US

V. Phone/Fax

Practice location:
  • Phone: 423-635-3035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4761
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: