Provider Demographics
NPI:1447563564
Name:MOORE, FARAH (MA, OTR/L)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 W PARMER LN
Mailing Address - Street 2:#3002
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-4615
Mailing Address - Country:US
Mailing Address - Phone:213-361-2829
Mailing Address - Fax:
Practice Address - Street 1:12710 RESEARCH BLVD
Practice Address - Street 2:SUITE 395
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4379
Practice Address - Country:US
Practice Address - Phone:800-280-4316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-18
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113790225X00000X
CA7136225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist