Individual
MICKEY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSOT
Contact information
Practice address
3203 N SANTA ANNA ST, CHANDLER, AZ 85224-1214
(480) 748-3519
Mailing address
3203 N SANTA ANNA ST, CHANDLER, AZ 85224-1214
(480) 748-3519
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0264-P
AZ
Other
Enumeration date
01/14/2014
Last updated
01/14/2014
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