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General NPI Number Information
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NPI Number | 1447193669
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Entity Type | Individual
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Provider Name | DANIELLE SIMIN MOORE
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Gender | Female
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Dates
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Enumeration Date | 04/13/2026
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Last Update Date | 04/13/2026
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Provider Practice Location Address
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Address Line | 9975 W STATE HIGHWAY 29 APT 417
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City | LIBERTY HILL
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State | TX
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Zip | 78642-0690
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Country | US
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Telephone | 512-987-5889
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Fax |
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Provider Business Mailing Address
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Address Line | 9073 W STATE HIGHWAY 29 STE 110
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City | LIBERTY HILL
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State | TX
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Zip | 78642-2396
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Country | US
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Telephone |
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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 | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 06014286
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License Number State | TX
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