Provider Demographics
NPI:1265959845
Name:MOORE, ALLISON LEIGH (OTR/L)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEIGH
Last Name:MOORE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712B WHALERS WAY
Mailing Address - Street 2:SUITE B200
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3314
Mailing Address - Country:US
Mailing Address - Phone:970-658-0688
Mailing Address - Fax:
Practice Address - Street 1:712B WHALERS WAY
Practice Address - Street 2:SUITE B200
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-658-0688
Practice Address - Fax:970-225-8113
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.004773225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist