MEDICARE: MS. KATHY S MOORE B.A.

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1265667182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHY S MOORE B.A.

Provider Business Mailing Address
First Line	:	87 N CANTON RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44305-3838
Country	:	US
Telephone Number	:	330-794-4254
Fax Number	:	330-794-4262

Provider Business Practice Location Address
First Line	:	5566 CHEVIOT RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7094
Country	:	US
Telephone Number	:	513-618-8300
Fax Number	:	513-618-8319

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

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	11/17/2022

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