MEDICARE: MS. MARY ALEXY MOORE SPEECH PATHOLOGY

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	235Z00000X	Speech-Language Pathologist	SA2300	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740291699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ALEXY MOORE SPEECH PATHOLOGY

Provider Business Mailing Address
First Line	:	11870 SUELLEN CIR
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6272
Country	:	US
Telephone Number	:	561-798-9537
Fax Number	:	561-753-7022

Provider Business Practice Location Address
First Line	:	12955 PALMS WEST DR
Second Line	:	SUITE 202, BUILDING 8
City	:	LOXAHATCHEE
State	:	FL
Zip	:	33470-4993
Country	:	US
Telephone Number	:	561-753-7010
Fax Number	:	561-753-7022

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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Directions to “ MS. MARY ALEXY MOORE SPEECH PATHOLOGY” Practice Location

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