Healthcare Provider Details

I. General information

NPI: 1982667457
Provider Name (Legal Business Name): ASHLEY JANE MOREE L.A.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 RR 620 N
AUSTIN TX
78738
US

IV. Provider business mailing address

417 FANTAIL LOOP
LAKEWAY TX
78734-4871
US

V. Phone/Fax

Practice location:
  • Phone: 512-533-6051
  • Fax:
Mailing address:
  • Phone: 512-533-6051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT2954
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: