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General NPI Number Information
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NPI Number | 1871965467
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Entity Type | Individual
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Provider Name | NATHANAEL DAVID MOORE OTR/L
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Gender | Male
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 1211 VIRGINIA ST
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City | GREENSBORO
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State | NC
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Zip | 27401-1313
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Country | US
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Telephone | 336-275-0927
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Fax | 336-275-4834
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Provider Business Mailing Address
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Address Line | 2219 GRIFFITH DR
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City | ORANGEBURG
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State | SC
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Zip | 29118-4011
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Country | US
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Telephone | 412-708-1153
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 009313
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | 5674
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | 9958
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 020010
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OC014112
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License Number State | PA
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