Provider Demographics
NPI:1578966305
Name:MOORHOUSE, CELIA FAYE (OTR)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:FAYE
Last Name:MOORHOUSE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 ADOBE RD
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-2356
Mailing Address - Country:US
Mailing Address - Phone:760-367-1743
Mailing Address - Fax:760-367-1083
Practice Address - Street 1:5930 ADOBE RD
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-2356
Practice Address - Country:US
Practice Address - Phone:760-367-1743
Practice Address - Fax:760-367-1083
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14703225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14703OtherOCCUPATIONAL THERAPIST LICENSE
CA331415OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY