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NPI Code Detail

MEDICARE: AUTUMN DIANE MOORE

MEDICARE: AUTUMN DIANE 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1457209348
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUTUMN DIANE MOORE
Provider Business Mailing Address
First Line : 350 FAIRWAY DR STE 101
Second Line :
City : DEERFIELD BEACH
State : FL
Zip : 33441-1834
Country : US
Telephone Number : 877-418-2978
Fax Number : 866-500-2186
Provider Business Practice Location Address
First Line : 700 MILAM ST STE 1300
Second Line :
City : HOUSTON
State : TX
Zip : 77002-2736
Country : US
Telephone Number : 859-518-8817
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2026
Last Update Date : 03/18/2026

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Directions to “ AUTUMN DIANE MOORE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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