Provider Demographics
NPI:1386000719
Name:MOORHEAD, DENISE (ATC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MOORHEAD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E 1ST ST
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153-2747
Mailing Address - Country:US
Mailing Address - Phone:308-284-7333
Mailing Address - Fax:308-284-7334
Practice Address - Street 1:700 E 1ST ST
Practice Address - Street 2:SUITE A & B
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-2747
Practice Address - Country:US
Practice Address - Phone:308-284-7333
Practice Address - Fax:308-284-7334
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer