Basic Information
| Provider Information | |||||||||
| NPI: | 1427460351 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | LAURICE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 LARCHMONT LN | ||||||||
| Address2: | |||||||||
| City: | WEST GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193908824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023796576 | ||||||||
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| Practice Location | |||||||||
| Address1: | 61 CORPORATE CIR | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197202405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023244444 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2014 | ||||||||
| LastUpdateDate: | 06/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | U2-0001966 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.