Organization
LSA PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHEON NESHELL MOORE (OWNER)
(901) 674-2877
Entity
Organization
Contact information
Practice address
1502 GOODMAN RD W, HORN LAKE, MS 38637-1407
(901) 674-2877
Mailing address
14132 STRAFFORD LN, OLIVE BRANCH, MS 38654-8462
(901) 674-2877
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
04/08/2026
Last updated
04/08/2026
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