Provider Demographics
NPI:1437881299
Name:MOORELAND, ANNI MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:ANNI
Middle Name:MARIE
Last Name:MOORELAND
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ANNI
Other - Middle Name:MARIE
Other - Last Name:HOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:341 THISTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-2960
Mailing Address - Country:US
Mailing Address - Phone:317-760-8904
Mailing Address - Fax:
Practice Address - Street 1:8425 CASTLETON CORNER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-3580
Practice Address - Country:US
Practice Address - Phone:317-760-8904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002336A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer