Individual
OTERRIOUS L MOOREHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4744 WE ROSS PKWY APT 52-104, SOUTHAVEN, MS 38671-7007
(601) 622-0555
Mailing address
4744 WE ROSS PKWY APT 52-104, SOUTHAVEN, MS 38671-7007
(601) 622-0555
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-175696
TN
Other
Enumeration date
06/01/2022
Last updated
06/01/2022
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