Individual
MR. DANIEL WAYNE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
835 E POPLAR AVE, SELMER, TN 38375-1832
(731) 645-3201
Mailing address
1510 WOODVILLE RD, BETHEL SPRINGS, TN 38315-4014
(731) 645-4041
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TN0000000722
TN
Other
Enumeration date
11/24/2006
Last updated
07/08/2007
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