Individual
MR. JASON ELLIS MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
35 EDMAR AVE, MARIETTA, OH 45750-7603
(740) 373-0761
Mailing address
35 EDMAR AVE, MARIETTA, OH 45750-7603
(740) 373-0761
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
1318
WV
225X00000X
Occupational Therapist
Primary
OT.006728
OH
Other
Enumeration date
05/17/2007
Last updated
07/08/2007
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