Provider Demographics
NPI:1336577766
Name:CHAMBERS MOORE, MONITA JEWEL (MSOT, OTR)
Entity Type:Individual
Prefix:
First Name:MONITA
Middle Name:JEWEL
Last Name:CHAMBERS MOORE
Suffix:
Gender:M
Credentials:MSOT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WIGGINS PKWY
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-1400
Mailing Address - Country:US
Mailing Address - Phone:972-686-3760
Mailing Address - Fax:
Practice Address - Street 1:900 WIGGINS PKWY
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-1400
Practice Address - Country:US
Practice Address - Phone:972-686-3760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110480225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist