Individual
DIANA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
342 BIRNIE AVE, SPRINGFIELD, MA 01107-1104
(413) 739-3954
(413) 785-1728
Mailing address
186 COUNTRY RD, AGAWAM, MA 01001-1613
(413) 883-9371
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
12186
MA
Other
Enumeration date
07/20/2017
Last updated
07/20/2017
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