Individual
LISA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
3949 SUNFOREST CT, TOLEDO, OH 43623-4473
(419) 474-3399
Mailing address
2827 JODORE AVE, TOLEDO, OH 43606-2741
(419) 461-0710
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT5068
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000217661
ANTHEM
OH
05
—
2208864
—
OH
01
—
9336626
PHCS
OH
Enumeration date
07/24/2007
Last updated
07/24/2007
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