Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT.0000770 | CO |
NPI | 1003370859 |
---|---|
Provider Name | Christina L Moore |
First Address | Grand Junction, CO 81502-5517 |
Second Address | Grand Junction, CO 81506-2863 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2019 |
Last Update Date | 23/12/2019 |