MEDICARE: SHENICKI COLEMAN 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	225X00000X	Occupational Therapist	28310	CA
2	225X00000X	Occupational Therapist	OT-2804	NV
3	225X00000X	Occupational Therapist		CO
4	225XP0019X	Physical Rehabilitation Occupational Therapist
5	225XG0600X	Gerontology Occupational Therapist
6	225X00000X	Occupational Therapist	116327	TX
7	225XG0600X	Gerontology Occupational Therapist		TX

General Provider Information

NPI Number	:	1336629708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHENICKI COLEMAN MOORE

Provider Business Mailing Address
First Line	:	3540 VALMONT AVE
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77706-6730
Country	:	US
Telephone Number	:	601-665-8117
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 S MASON RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-3895
Country	:	US
Telephone Number	:	281-652-5200
Fax Number	:	818-357-2505

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

Provider Enumeration Date	:	08/15/2018
Last Update Date	:	06/10/2026

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Directions to “ SHENICKI COLEMAN MOORE ” Practice Location

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