Provider Demographics
NPI:1518052513
Name:MOORE, JANE RUTH (OTRL CHT)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:RUTH
Last Name:MOORE
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 LANCASTER AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3256
Mailing Address - Country:US
Mailing Address - Phone:610-640-4133
Mailing Address - Fax:610-640-0630
Practice Address - Street 1:266 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3256
Practice Address - Country:US
Practice Address - Phone:610-640-4133
Practice Address - Fax:610-640-0630
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005443L225X00000X
PA1041100204225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
062907QZYMedicare ID - Type Unspecified