Individual
JEREMY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AAOT
Contact information
Practice address
3550 SE WOODWARD ST, PORTLAND, OR 97202-1552
(503) 517-8663
(503) 943-4994
Mailing address
740 NE 53RD AVE APT 33, PORTLAND, OR 97213-3164
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/08/2008
Last updated
10/08/2008
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