Healthcare Provider Details

I. General information

NPI: 1942918883
Provider Name (Legal Business Name): MICHELLE B MOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 2ND AVE S
KENT WA
98032-5847
US

IV. Provider business mailing address

3815 S OTHELLO ST STE 100
SEATTLE WA
98118-3510
US

V. Phone/Fax

Practice location:
  • Phone: 425-246-7038
  • Fax: 253-981-4872
Mailing address:
  • Phone: 206-930-2438
  • Fax: 206-299-9327

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: