Provider Demographics
NPI:1295164234
Name:MOORE, RUTH ANN (OT)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NORTH STREET
Mailing Address - Street 2:TENDER CARE
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763
Mailing Address - Country:US
Mailing Address - Phone:989-362-8645
Mailing Address - Fax:989-362-4462
Practice Address - Street 1:400 NORTH ST W
Practice Address - Street 2:TENDER CARE
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9161
Practice Address - Country:US
Practice Address - Phone:989-362-8645
Practice Address - Fax:989-362-4462
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2247921174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist