Individual
MR. JASON ROBERT MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
1045 JAMES ST, SYRACUSE, NY 13203-2730
(315) 425-1004
(315) 422-4855
Mailing address
1045 JAMES ST, SYRACUSE, NY 13203-2730
(315) 425-1004
(315) 422-4855
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
021340-1
NY
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021340-1
REGISTERED OCCUPATIONAL THERAPIST
NY
Enumeration date
05/15/2017
Last updated
07/21/2022
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