MEDICARE: MS. LEIGH ANN MOORE OTR

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	225XH1200X	Hand Occupational Therapist	105495	TX
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1225159346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEIGH ANN MOORE OTR

Provider Business Mailing Address
First Line	:	2001 BUTTERFIELD RD STE 1600
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 E PRESIDENT GEORGE BUSH HWY STE 103
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-3565
Country	:	US
Telephone Number	:	972-470-5005
Fax Number	:	972-470-5009

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	01/06/2025

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