Provider Demographics
NPI:1326913534
Name:MOORE, HEATHER
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 OLD STATE ROUTE 38 NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURTHOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1248 OLD STATE ROUTE 38 NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURTHOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160
Practice Address - Country:US
Practice Address - Phone:614-493-6535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-07
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4001688210023747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant