Provider Demographics
NPI:1710023627
Name:MCBRIDE, MOIRA BRIGID
Entity Type:Individual
Prefix:
First Name:MOIRA
Middle Name:BRIGID
Last Name:MCBRIDE
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:PO BOX 1681
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-1681
Mailing Address - Country:US
Mailing Address - Phone:907-747-7311
Mailing Address - Fax:907-747-3368
Practice Address - Street 1:110 AMERICAN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7534
Practice Address - Country:US
Practice Address - Phone:907-966-2411
Practice Address - Fax:907-966-8606
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK343225XP0200X
AK225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOT93291Medicaid