Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT16006 | FL |
N | 225XM0800X | Mental Health | ||
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | ||
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1083038350 |
---|---|
Provider Name | Sandra Moore |
First Address | Apo, AE 09720-0003 |
Second Address | Apo, AE 09720-0003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2014 |
Last Update Date | 07/02/2014 |