Provider Demographics
NPI:1447778782
Name:MOORE, DEBORAH MARCELLA (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:MARCELLA
Last Name:MOORE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 FORT LYON DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1010
Mailing Address - Country:US
Mailing Address - Phone:770-881-0870
Mailing Address - Fax:
Practice Address - Street 1:9300 ONYX CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-9329
Practice Address - Country:US
Practice Address - Phone:540-898-8238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAO131OO1848224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant