Provider Demographics
NPI:1114068665
Name:MORAN, JOHN P (OT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:MORAN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 INDIAN ROCK RD STE 11
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1691
Mailing Address - Country:US
Mailing Address - Phone:603-952-4560
Mailing Address - Fax:603-952-4561
Practice Address - Street 1:25 INDIAN ROCK RD STE 11
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1691
Practice Address - Country:US
Practice Address - Phone:603-952-4560
Practice Address - Fax:603-952-4561
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1194225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist