Provider Demographics
NPI:1598337198
Name:MOORE, MAELYNN (ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:MAELYNN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6349 CEDAR PLZ APT 311
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2289
Mailing Address - Country:US
Mailing Address - Phone:785-640-9356
Mailing Address - Fax:
Practice Address - Street 1:6001 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68182-1102
Practice Address - Country:US
Practice Address - Phone:402-554-4997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer