Provider Demographics
NPI:1609514553
Name:MOORE, BRITTANY (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8413 SASANQUA CIR
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-5551
Mailing Address - Country:US
Mailing Address - Phone:251-463-0966
Mailing Address - Fax:
Practice Address - Street 1:8413 SASANQUA CIR
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-5551
Practice Address - Country:US
Practice Address - Phone:251-463-0966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-21
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3572225X00000X
CA21727225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist