Individual
JONATHAN TUCKER MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
1949 GRANT RD, MOUNTAIN VIEW, CA 94040-3217
(650) 968-2990
Mailing address
1266 PRISCILLA DR, SAN JOSE, CA 95129-4324
(650) 391-4041
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
19759
CA
Other
Enumeration date
09/24/2021
Last updated
09/24/2021
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