Provider Demographics
NPI:1639699382
Name:MOORE, KEARSTYN MARQUIS (ATC)
Entity Type:Individual
Prefix:
First Name:KEARSTYN
Middle Name:MARQUIS
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 1:486 S RIVER ST
Mailing Address - Street 2:
Mailing Address - City:NEWCOMERSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43832-1444
Mailing Address - Country:US
Mailing Address - Phone:330-556-9370
Mailing Address - Fax:
Practice Address - Street 1:486 S RIVER ST
Practice Address - Street 2:
Practice Address - City:NEWCOMERSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43832-1444
Practice Address - Country:US
Practice Address - Phone:330-556-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer