Individual
MRS. GLENDA MARIE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O. T.
Contact information
Practice address
371 SERENO RD, CORRALES, NM 87048-8625
(505) 352-7391
(505) 352-7391
Mailing address
371 SERENO RD, CORRALES, NM 87048-8625
(505) 352-7391
(505) 352-7391
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1107
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A2161
—
NM
05
—
Q6968
—
NM
Enumeration date
02/12/2007
Last updated
07/09/2007
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