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General NPI Number Information
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NPI Number | 1700855434
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Entity Type | Individual
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Provider Name | CAITLIN MOORE SUND MHS OTRL
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Gender | Female
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10508 PARK RD SUITE 130
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City | CHARLOTTE
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State | NC
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Zip | 28210-8405
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Country | US
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Telephone | 704-541-9080
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Fax |
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Provider Business Mailing Address
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Address Line | 3105 WELL HOUSE CT
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City | CHARLOTTE
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State | NC
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Zip | 28210-7932
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Country | US
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Telephone | 704-541-9080
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 5695
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 11281
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License Number State | FL
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