Individual
MS. SHAMORRA T MOTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4061 SUZANNE DR # CD, DIBERVILLE, MS 39540-3735
(228) 396-4434
(228) 396-4438
Mailing address
4061 SUZANNE DR # CD, DIBERVILLE, MS 39540-3735
(228) 396-4434
(228) 396-4438
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22249379
—
MS
Enumeration date
12/20/2022
Last updated
12/20/2022
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