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NPI Code Detail

MEDICARE: TAMMY MOORE

MEDICARE: TAMMY MOORE
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1013488477
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY MOORE
Provider Business Mailing Address
First Line : 6763 PAGE AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63133-1635
Country : US
Telephone Number : 317-250-3575
Fax Number :
Provider Business Practice Location Address
First Line : 6763 PAGE AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63133-1635
Country : US
Telephone Number : 317-250-3575
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2018
Last Update Date : 12/11/2018

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Directions to “ TAMMY MOORE ” Practice Location

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