Provider Demographics
NPI:1801383690
Name:MOORE, CLAUDIA MARLENE (OTA)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:MARLENE
Last Name:MOORE
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:CLAUDIA
Other - Middle Name:MARLENE
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:991 NW LEONARDO CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-4351
Mailing Address - Country:US
Mailing Address - Phone:305-742-3855
Mailing Address - Fax:
Practice Address - Street 1:991 NW LEONARDO CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-4351
Practice Address - Country:US
Practice Address - Phone:305-742-3855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15428224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant