Individual
MRS. STACEY L S MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
2895 SE POWELL VALLEY RD, GRESHAM, OR 97080-1492
(971) 571-5319
Mailing address
12806 NE SAN RAFAEL ST, PORTLAND, OR 97230-1826
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1073412
OR
225X00000X
Occupational Therapist
OC-009631
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101847812 0001
—
PA
Enumeration date
12/27/2006
Last updated
09/19/2023
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