Provider Demographics
NPI:1770301988
Name:MOORE, OLIVIA MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARIE
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 1:8 FLIRTATION AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PRESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06777-1708
Mailing Address - Country:US
Mailing Address - Phone:203-417-0762
Mailing Address - Fax:
Practice Address - Street 1:29 FEDERAL RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5010
Practice Address - Country:US
Practice Address - Phone:203-874-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6515225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist