Individual
CANDICE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
105A WINDMILL CV, GRENADA, MS 38901-9305
(662) 299-6918
Mailing address
105A WINDMILL CV, GRENADA, MS 38901-9305
(662) 299-6918
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1829
MS
Other
Enumeration date
11/10/2014
Last updated
11/10/2014
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