Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OTT Z11161 | LA |
NPI | 1134554041 |
---|---|
Provider Name | Mrs. Kelli Moore |
First Address | New Orleans, LA 70122-5003 |
Second Address | New Orleans, LA 70122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2013 |
Last Update Date | 10/09/2013 |