Provider Demographics
NPI:1831323476
Name:MOORE, REBECCA CAROL
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CAROL
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:CAROL
Other - Last Name:LAVOIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:80 PALOMINO LN
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6447
Mailing Address - Country:US
Mailing Address - Phone:603-669-7716
Mailing Address - Fax:603-669-0103
Practice Address - Street 1:80 PALOMINO LN
Practice Address - Street 2:STE 401
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6447
Practice Address - Country:US
Practice Address - Phone:603-669-7716
Practice Address - Fax:603-669-0103
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0855225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30410122Medicaid