MEDICARE: DENISE MOORE REVEL MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	03882	MD

General Provider Information

NPI Number	:	1013231364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE MOORE REVEL MS

Provider Business Mailing Address
First Line	:	14625 BALTIMORE AVE
Second Line	:	SUITE 864
City	:	LAUREL
State	:	MD
Zip	:	20707-4902
Country	:	US
Telephone Number	:	866-570-0442
Fax Number	:

Provider Business Practice Location Address
First Line	:	7909 BELLE POINT DR
Second Line	:
City	:	GREENBELT
State	:	MD
Zip	:	20770-3329
Country	:	US
Telephone Number	:	866-570-0442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2010
Last Update Date	:	03/16/2010

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Directions to “ DENISE MOORE REVEL MS” Practice Location

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