Individual
KENNETH MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 MCKINLEY AVE, HARRISVILLE, WV 26362-1150
(304) 643-2717
Mailing address
10920 INLAND RD, CAMBRIDGE, OH 43725-8694
(681) 264-0452
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1099
WV
Other
Enumeration date
11/23/2023
Last updated
11/23/2023
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