Provider Demographics
NPI:1568826899
Name:MOORE, LAUREN E (ATC)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:E
Last Name:MOORE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WARRIOR WAY
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9241
Mailing Address - Country:US
Mailing Address - Phone:843-586-8500
Mailing Address - Fax:
Practice Address - Street 1:1000 WARRIOR WAY
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-9241
Practice Address - Country:US
Practice Address - Phone:843-586-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCBOC1764002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer