Provider Demographics
NPI:1295285971
Name:MOORE, MARQUETTA ROBIN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MARQUETTA
Middle Name:ROBIN
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 1:6185 LORETTO RD
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-9391
Mailing Address - Country:US
Mailing Address - Phone:606-627-2109
Mailing Address - Fax:
Practice Address - Street 1:6185 LORETTO RD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-9391
Practice Address - Country:US
Practice Address - Phone:606-627-2109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY170847225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist