Healthcare Provider Details

I. General information

NPI: 1588630131
Provider Name (Legal Business Name): ELIZABETH A MOYER O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE 1206 HEALTH SCIENCE CENTER SOUTH
MORGANTOWN WV
26506
US

IV. Provider business mailing address

PO BOX 897
MORGANTOWN WV
26507-0897
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4800
  • Fax: 304-293-6963
Mailing address:
  • Phone: 304-293-7401
  • Fax: 304-293-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1207
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: