Individual
KENYON LAROYCE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
310 SOUTH FOURTH STREET, WILTON, AR 71865
(870) 331-3184
Mailing address
310 SOUTH FOURTH STREET, WILTON, AR 71865
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
213345
TX
Other
Enumeration date
02/01/2019
Last updated
02/01/2019
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