Provider Demographics
NPI:1417154469
Name:MOORE, JANET L (COTAL)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 BARKLEY CIR
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-9300
Mailing Address - Country:US
Mailing Address - Phone:270-522-9473
Mailing Address - Fax:
Practice Address - Street 1:124 WEST NASHVILLE STREET
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:KY
Practice Address - Zip Code:42266
Practice Address - Country:US
Practice Address - Phone:270-475-4227
Practice Address - Fax:270-475-4173
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAO626224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant