Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1942498712 |
---|---|
Provider Name | Mr. Scott Moore |
First Address | Clarksville, TN 37040-1917 |
Second Address | Clarksville, TN 37040-1917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2007 |
Last Update Date | 05/10/2007 |