=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366537607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPEAK MOOR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 05/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7368 N LA CHOLLA BLVD
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85741-2305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-742-3092
-----------------------------------------------------
Fax | 520-544-9497
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7368 N LA CHOLLA BLVD 7368 N. LA CHOLLA BLVD
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85741-2305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-742-3092
-----------------------------------------------------
Fax | 520-544-9497
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH PATHOLOGIST/OWNER
-----------------------------------------------------
Name | MRS. SHERI B MOORMANN
-----------------------------------------------------
Credential | M.S. CCC-SLP
-----------------------------------------------------
Telephone | 520-742-3092
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 1060
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 6540
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SLP0161
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------