Individual
DIANE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1221 DURSTON RD, BOZEMAN, MT 59715-2725
(406) 582-3300
Mailing address
13 TRAVERTINE LN TRLR 10, LIVINGSTON, MT 59047-4125
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTP-OTA-LIC-2052
MT
Other
Enumeration date
09/17/2013
Last updated
09/17/2013
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