Provider Demographics
NPI:1013220425
Name:MOORE, JOSEPH L JR (OTD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8433 MINERAL SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-2418
Mailing Address - Country:US
Mailing Address - Phone:866-404-1835
Mailing Address - Fax:
Practice Address - Street 1:8433 MINERAL SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-2418
Practice Address - Country:US
Practice Address - Phone:866-404-1835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003423225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist