Provider Demographics
NPI:1922308568
Name:MOORE THERAPY LLC
Entity Type:Organization
Organization Name:MOORE THERAPY LLC
Other - Org Name:MOORE THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:907-306-1728
Mailing Address - Street 1:5632 EAST 40TH STREET
Mailing Address - Street 2:UNIT E301
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504
Mailing Address - Country:US
Mailing Address - Phone:907-306-1728
Mailing Address - Fax:907-332-1728
Practice Address - Street 1:5632 E 40TH AVE
Practice Address - Street 2:UNIT E301
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4359
Practice Address - Country:US
Practice Address - Phone:907-306-1728
Practice Address - Fax:907-332-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKOT1318225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty