Otha Moore

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

7153185 Issued in MI

Practice address

18430 Westhampton
Southfield, MI 48075

Phone

(313) 844-1496

NPI assigned

Sep 22, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442880000000",
    "number": "1275902132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18430 WESTHAMPTON AVE",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754116",
            "telephone_number": "313-844-1496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18430 WESTHAMPTON",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48075",
            "telephone_number": "313-844-1496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "OTHA",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-22",
        "last_updated": "2015-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MI",
            "license": "7153185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Joyce Moore
• Linell C Moore
• Lisa Jeanine Moore, LMSW
• Madeline Grace Moore
• Monesha Maria Moore
• Patricia Ann Moore
• Shayla Moore, LLPC
• Talisa Renee Moore
• Teasia Moore
• Kandice Sakeena Moorman

• Exclusive Provider Organization in Southfield, MI
• Providers in Southfield, MI by specialty
• Exclusive Provider Organization in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.