Provider Demographics
NPI:1326592783
Name:MOORE, MARNA LYNN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:MARNA
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4966 E EVANS DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2852
Mailing Address - Country:US
Mailing Address - Phone:623-256-5682
Mailing Address - Fax:
Practice Address - Street 1:17100 E SHEA BLVD STE 225
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6744
Practice Address - Country:US
Practice Address - Phone:480-837-4565
Practice Address - Fax:888-957-8277
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4301225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics