Provider Demographics
NPI:1689630642
Name:MOORE, TAMEIKA (ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:TAMEIKA
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 1:11942 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:KEITHVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71047-7370
Mailing Address - Country:US
Mailing Address - Phone:318-426-7206
Mailing Address - Fax:
Practice Address - Street 1:11942 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:KEITHVILLE
Practice Address - State:LA
Practice Address - Zip Code:71047-7370
Practice Address - Country:US
Practice Address - Phone:318-426-7206
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAJ002842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer