MEDICARE: JENNIFER 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

General Provider Information

NPI Number	:	1760526636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MOORE

Provider Business Mailing Address
First Line	:	227 MAPLELEAF CIR
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-3372
Country	:	US
Telephone Number	:	501-262-4101
Fax Number	:

Provider Business Practice Location Address
First Line	:	2837 MALVERN AVE
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-8321
Country	:	US
Telephone Number	:	501-262-1724
Fax Number	:	501-262-6227

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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Directions to “ JENNIFER MOORE ” Practice Location

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