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General NPI Number Information
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NPI Number | 1528933298
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Entity Type | Individual
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Provider Name | LEXIE ROSE MOORE OTD
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Gender | Female
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Dates
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Enumeration Date | 10/10/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 2869 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60657-4201
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Country | US
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Telephone | 773-665-9950
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Fax |
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Provider Business Mailing Address
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Address Line | 976 SAINT ANDREWS CIR
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City | GENEVA
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State | IL
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Zip | 60134-2997
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Country | US
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Telephone | 630-360-4390
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Fax | 630-360-4390
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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 | 056.016656
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License Number State | IL
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