MEDICARE: MARISA MOORE OTR, CLT

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	116262	TX

General Provider Information

NPI Number	:	1548750649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA MOORE OTR, CLT

Provider Business Mailing Address
First Line	:	7081 SIENA PL APT 428
Second Line	:
City	:	THE COLONY
State	:	TX
Zip	:	75056-5364
Country	:	US
Telephone Number	:	479-366-8530
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 OHIO DR STE 105
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5331
Country	:	US
Telephone Number	:	972-599-9594
Fax Number	:	972-599-9364

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

Provider Enumeration Date	:	05/14/2018
Last Update Date	:	05/14/2018

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Directions to “ MARISA MOORE OTR, CLT” Practice Location

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