Individual
MRS. RENA ANN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
695 MITZI ST, MUSKEGON, MI 49445-3232
(231) 744-1641
Mailing address
2600 COMPASS RD, GLENVIEW, IL 60026-8001
(877) 787-3430
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201009053
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17992
—
IL
Enumeration date
07/23/2021
Last updated
07/23/2021
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