Individual
CANDICE M. MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR L
Contact information
Practice address
4500 INTERSTATE 55 NORTH, SUITE 291, HIGHLAND VILLAGE, JACKSON, MS 39211
(601) 362-0859
(601) 362-0870
Mailing address
766 CLEARMONT DR, PEARL, MS 39208-6261
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1713
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05170357
—
MS
Enumeration date
11/24/2006
Last updated
07/08/2007
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