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General NPI Number Information
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NPI Number | 1114545456
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Entity Type | Individual
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Provider Name | CAITLYN MARIE MOORE
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Gender | Female
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 1548 MINONITE RD STE 820
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City | ROSENBERG
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State | TX
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Zip | 77469-1281
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Country | US
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Telephone | 345-533-4221
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Fax |
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Provider Business Mailing Address
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Address Line | 1822 TURTLE BLUFF LN
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City | BOOTH
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State | TX
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Zip | 77469-2993
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Country | US
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Telephone | 512-783-5301
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-77957
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | TX
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