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General NPI Number Information
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NPI Number | 1013269422
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Entity Type | Individual
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Provider Name | NICHOLE MOORE
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Gender | Female
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 3511 W MARKET ST STE. B
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City | GREENSBORO
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State | NC
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Zip | 27403-4443
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Country | US
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Telephone | 336-294-3338
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Fax | 336-294-6696
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Provider Business Mailing Address
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Address Line | 604 PEACH ORCHARD DR
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City | BROWNS SUMMIT
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State | NC
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Zip | 27214-9498
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Country | US
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Telephone | 336-543-4381
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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