Individual
BRIAN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 THORNBERRY BRANCH LN, DAYTONA BEACH, FL 32124
(386) 872-4892
Mailing address
2306 BRIAN AVE, SOUTH DAYTONA, FL 32119-2724
(401) 286-7663
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
08/28/2017
Last updated
06/28/2018
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