Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1003569757 |
---|---|
Provider Name | Megan Moore |
First Address | Woodstock, GA 30188-6444 |
Second Address | Woodstock, GA 30188-6444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2022 |
Last Update Date | 02/02/2022 |