MEDICARE: MOORE THERAPY SERVICES, P.C.

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	261QH0700X	Hearing and Speech Clinic/Center

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	:	1790452373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOORE THERAPY SERVICES, P.C.

Provider Business Mailing Address
First Line	:	152 BELLE MEADE DR
Second Line	:
City	:	BREWTON
State	:	AL
Zip	:	36426-4006
Country	:	US
Telephone Number	:	251-363-6213
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 FORREST AVE
Second Line	:
City	:	EAST BREWTON
State	:	AL
Zip	:	36426-2622
Country	:	US
Telephone Number	:	251-363-6213
Fax Number	:

Authorized Official
Title or Position	:	SPEECH/LANGUAGE PATHOLOGIST
Name	:	AMY COUCH MOORE
Credential	:	MS, CCC-SLP
Telephone Number	:	251-363-6213

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	08/23/2021

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