Individual
CODY MICHAEL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
15775 LAGUNA CANYON RD, STE 110, IRVINE, CA 92618-3189
(949) 333-3833
Mailing address
45 PALATINE, APPT 440, IRVINE, CA 92612-7628
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
11486
CA
Other
Enumeration date
05/31/2012
Last updated
05/31/2012
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