Individual
MICHAEL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
220 PEBBLE CREEK RD, POWELL, WY 82435-2271
(307) 254-3560
Mailing address
220 PEBBLE CREEK RD, POWELL, WY 82435-2271
(307) 254-3560
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
01/08/2016
Last updated
01/08/2016
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