Provider Demographics
NPI:1346302643
Name:MOORE, KATHRYN GRIFFITH (MA)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:GRIFFITH
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA
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Mailing Address - Street 1:PO BOX 1096
Mailing Address - Street 2:
Mailing Address - City:COBB
Mailing Address - State:CA
Mailing Address - Zip Code:95426-1096
Mailing Address - Country:US
Mailing Address - Phone:707-318-8168
Mailing Address - Fax:707-928-4905
Practice Address - Street 1:13652 ADAMS SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COBB
Practice Address - State:CA
Practice Address - Zip Code:95426-1096
Practice Address - Country:US
Practice Address - Phone:707-928-4905
Practice Address - Fax:707-928-4905
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist