Provider Demographics
NPI:1417079799
Name:MOORE-JONES, SHAUNTEL (OTRL)
Entity Type:Individual
Prefix:
First Name:SHAUNTEL
Middle Name:
Last Name:MOORE-JONES
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 1:15205 DIEKMAN CT
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-3119
Mailing Address - Country:US
Mailing Address - Phone:708-466-8351
Mailing Address - Fax:708-201-7468
Practice Address - Street 1:15205 DIEKMAN CT
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-3119
Practice Address - Country:US
Practice Address - Phone:708-466-8351
Practice Address - Fax:708-201-7468
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist