Individual
AMI MOFFO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12 CAROLINA AVE, BEECH BOTTOM, WV 26030-1006
(304) 374-6163
Mailing address
PO BOX 357, BEECH BOTTOM, WV 26030-0357
(304) 374-6163
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/30/2020
Last updated
10/30/2020
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