Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | 4897 | SC |
NPI | 1003498395 |
---|---|
Provider Name | Tonya Kay Moore |
First Address | Abbeville, SC 29620-5656 |
Second Address | Abbeville, SC 29620-5656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2021 |
Last Update Date | 26/04/2021 |