MEDICARE: KAYLA ELIZABETH 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
1	103K00000X	Behavior Analyst	BH005077	PA

General Provider Information

NPI Number	:	1306557335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA ELIZABETH MOORE

Provider Business Mailing Address
First Line	:	809 RIDGE AVE
Second Line	:
City	:	JEANNETTE
State	:	PA
Zip	:	15644-1643
Country	:	US
Telephone Number	:	724-961-9755
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 PELLIS RD STE 203
Second Line	:
City	:	GREENSBURG
State	:	PA
Zip	:	15601-4583
Country	:	US
Telephone Number	:	724-216-3358
Fax Number	:

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

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	12/12/2022

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