Individual
PAMELA MARIE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
6595 COLE RD, HAHIRA, GA 31632-3621
(229) 563-0811
(229) 794-8009
Mailing address
6595 COLE RD, HAHIRA, GA 31632-3621
(229) 563-0811
(229) 794-8009
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT003205
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000885849E
—
GA
Enumeration date
09/01/2005
Last updated
10/15/2012
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