Individual
MRS. JACEY MATTISON MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
238 BEREA RD, ELDRIDGE, AL 35554-4200
(205) 270-9025
Mailing address
238 BEREA RD, ELDRIDGE, AL 35554-4200
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6104
AL
Other
Enumeration date
03/08/2023
Last updated
04/03/2023
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