Provider Demographics
NPI:1548602766
Name:MOORE, DANA (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 NW LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-1543
Mailing Address - Country:US
Mailing Address - Phone:775-343-6180
Mailing Address - Fax:
Practice Address - Street 1:3200 NE 86TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-7327
Practice Address - Country:US
Practice Address - Phone:360-313-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR311517225X00000X
WAOT60775230225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist