Individual
MRS. TAMARA ALISHA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BEHAVIOR ANALYST
Contact information
Practice address
5720 OAKWOOD ST, SPENCER, OK 73084-8639
(405) 501-7453
Mailing address
5720 OAKWOOD ST, SPENCER, OK 73084-8639
(405) 501-7453
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1962707018
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200025790-B
—
OK
Enumeration date
06/23/2013
Last updated
06/23/2013
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