Individual
AMELIA B MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.R/L
Contact information
Practice address
290 BRANDYWINE BLVD, FAYETTEVILLE, GA 30214-1560
(770) 460-0165
(770) 460-0189
Mailing address
290 BRANDYWINE BLVD, FAYETTEVILLE, GA 30214-1560
(770) 460-0165
(770) 460-0189
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT003365
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000924822D
—
GA
Enumeration date
10/24/2006
Last updated
07/18/2014
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