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General NPI Number Information
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NPI Number | 1740806025
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Entity Type | Individual
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Provider Name | ASHELY MOORE
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Gender | Female
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 27 REINKE RD
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City | ELLISVILLE
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State | MO
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Zip | 63021-4700
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Country | US
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Telephone | 636-527-5554
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Fax |
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Provider Business Mailing Address
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Address Line | 2045 SPLENDOR DR
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City | FLORISSANT
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State | MO
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Zip | 63031-2637
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 2012028466
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License Number State | MO
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