Individual
JODI LYNN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L, CHT
Contact information
Practice address
3200 NORTHLINE AVE, STE 160, GREENSBORO, NC 27408-7616
(336) 545-5000
(336) 545-5020
Mailing address
7485 MISSION VALLEY RD, STE 104A, SAN DIEGO, CA 92108-4422
(336) 545-5000
(336) 545-5020
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
6526
NC
225X00000X
Occupational Therapist
OC 008606
PA
225XH1200X
Hand Occupational Therapist
Primary
18401
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6526
NC BOARD OCCUPATIONAL THERAPY
NC
01
—
PTAN Q40482A
MEDICARE PTAN
NC
Enumeration date
06/08/2007
Last updated
02/06/2019
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