Provider Demographics
NPI:1821542325
Name:MOORE, ELANOR (OTR)
Entity Type:Individual
Prefix:MISS
First Name:ELANOR
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 GREENE AVE APT 8B
Mailing Address - Street 2:BROOKLYN
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-2294
Mailing Address - Country:US
Mailing Address - Phone:646-577-2412
Mailing Address - Fax:
Practice Address - Street 1:339 GREENE AVE APT 8B
Practice Address - Street 2:BROOKLYN
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-2294
Practice Address - Country:US
Practice Address - Phone:646-577-2412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020763225X00000X
NJ46TR00741100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist