Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2015006593 | MO |
NPI | 1003352337 |
---|---|
Provider Name | Erika Moore |
First Address | Moberly, MO 65270-1471 |
Second Address | Columbia, MO 65203-1568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2017 |
Last Update Date | 10/01/2017 |