Individual
SAMATHA HALIE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
136 EAST TOWNSHEND, SHAWNEETOWN, IL 62984
(618) 926-0865
Mailing address
136 E TOWNSHEND AVE, SHAWNEETOWN, IL 62984-3215
(618) 926-0865
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003896
IL
224Z00000X
Occupational Therapy Assistant
32002601A
IN
Other
Enumeration date
03/12/2014
Last updated
03/12/2014
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