Provider Demographics
NPI:1033487681
Name:MOORE, DANIEL (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 KEYSER RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03216-4019
Mailing Address - Country:US
Mailing Address - Phone:603-735-5451
Mailing Address - Fax:
Practice Address - Street 1:7 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235-2000
Practice Address - Country:US
Practice Address - Phone:603-934-2541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH00621224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant