Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2260 | TN |
NPI | 1013349620 |
---|---|
Provider Name | Ms. Brandy Lee Moore |
First Address | Nashville, TN 37217-3457 |
Second Address | Nashville, TN 37217-3457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2013 |
Last Update Date | 06/08/2013 |