Provider Demographics
NPI:1457842056
Name:MORO, LAURIE (ATC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:MORO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:NUYENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:48758 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-2091
Mailing Address - Country:US
Mailing Address - Phone:586-214-7795
Mailing Address - Fax:
Practice Address - Street 1:48758 CHESTNUT DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-2091
Practice Address - Country:US
Practice Address - Phone:586-214-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-20
Last Update Date:2018-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010004962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer