Provider Demographics
NPI:1639214315
Name:MOFFATT, NORMA JEAN
Entity Type:Individual
Prefix:MS
First Name:NORMA
Middle Name:JEAN
Last Name:MOFFATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 BOWMAN DR # B
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3858
Mailing Address - Country:US
Mailing Address - Phone:330-678-1668
Mailing Address - Fax:330-673-1037
Practice Address - Street 1:208 BOWMAN DR # B
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3858
Practice Address - Country:US
Practice Address - Phone:330-678-1668
Practice Address - Fax:330-673-1037
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services