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General NPI Number Information
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NPI Number | 1700299344
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Entity Type | Individual
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Provider Name | KAROL MOORE O.T..
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Gender | Female
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 500 HOSPITAL DR
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City | CRESTVIEW
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State | FL
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Zip | 32539-7355
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Country | US
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Telephone | 850-419-4874
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Fax |
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Provider Business Mailing Address
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Address Line | 366 PARADISE ISLAND DR LOT F-5
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City | DEFUNIAK SPRINGS
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State | FL
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Zip | 32433-7014
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Country | US
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Telephone | 850-419-4874
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA 13061
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License Number State | FL
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