Individual
SHERONDA CHANTELL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSOT, OTR/L
Contact information
Practice address
7136 GETTYSBURG PIKE, FORT WAYNE, IN 46804-5680
(260) 745-3322
Mailing address
8040 UPLAND CT, INDIANAPOLIS, IN 46278-9585
(803) 837-2652
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
88001256A
IN
225X00000X
Occupational Therapist
3992
SC
225X00000X
Occupational Therapist
9065
NC
Other
Enumeration date
12/17/2015
Last updated
03/29/2024
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