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General NPI Number Information
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NPI Number | 1164729463
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Entity Type | Individual
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Provider Name | LAURIE JOHNSON MOORE OTR
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Gender | Female
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Dates
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Enumeration Date | 02/22/2011
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Last Update Date | 02/22/2011
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Provider Practice Location Address
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Address Line | 1815 ENCLAVE PKWY APT. 6307
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City | HOUSTON
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State | TX
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Zip | 77077-3671
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Country | US
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Telephone | 281-920-0573
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Fax |
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Provider Business Mailing Address
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Address Line | 1307 TRACEWOOD CV
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City | HOUSTON
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State | TX
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Zip | 77077-1546
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Country | US
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Telephone | 281-589-0789
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 107672
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License Number State | TX
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