Individual
MARA BETH MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LOTR
Contact information
Practice address
702 PROFESSIONAL DR N, SHREVEPORT, LA 71105-5600
(870) 914-1809
Mailing address
702 N PROFESSIONAL DR, SHREVEPORT, LA 71105
(318) 746-1199
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
338817
LA
Other
Enumeration date
11/13/2024
Last updated
11/13/2024
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