Brandi Moore

Individual provider Active NPI Occupational Therapist · Odessa, DE

NPI 1063979581 · NPPES record last updated Feb 21, 2019

Key facts

NPI
1063979581
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapist 225X00000X
License
U1-0001998 (DE)
Practice address
313 S 5TH St
Odessa, DE 19730-2078
Phone
(302) 376-4128
NPI assigned
Feb 21, 2019
Sex
Female
Sole proprietor
Yes

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
U1-0001998DEMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
State of Delaware Past Accepting new patients
Kidztherapy Networks Inc Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X U1-0001998 DE Yes

Addresses

Primary practice location

313 S 5TH St
Odessa, DE 19730-2078

Mailing address

5424 Killens Pond Rd
Felton, DE 19943-1902
Phone (302) 284-5810

Other identifiers

IdentifierTypeStateIssuer
U1-0001998OtherDESTATE OF DELAWARE

Other providers in Odessa, DE

All providers in Odessa, DE · Occupational Therapist in Delaware

Sources for this page

Verify at the official NPI Registry.