Provider Demographics
NPI:1689997918
Name:MOORE, JANE HWANG (OT)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:HWANG
Last Name:MOORE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 VIA CALLEJON
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6213
Mailing Address - Country:US
Mailing Address - Phone:949-498-5100
Mailing Address - Fax:949-366-5665
Practice Address - Street 1:1120 VIA CALLEJON
Practice Address - Street 2:SUITE B
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6213
Practice Address - Country:US
Practice Address - Phone:949-498-5100
Practice Address - Fax:949-366-5665
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT10856225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist