Individual
ANGEL MORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
908 N REYNOLDS RD, BRYANT, AR 72022-3034
(479) 967-2322
Mailing address
PO DRAWER 2109, RUSSELLVILLE, AR 72811
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176177795
—
AR
Enumeration date
06/24/2009
Last updated
06/24/2009
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