Holly Georgiana Moore, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA002554 Issued in GA

Practice address

1401 Tift Ave N Ste B
Tifton, GA 31794-3577

Phone

(229) 396-5644

Fax

(855) 565-1769

NPI assigned

Nov 28, 2022

Last updated

Nov 28, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Theraplay LLC

  • Pediatrics Physician
  • Tifton, GA
  • NPI 1225704802
  NPD

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

{
    "created_epoch": "1669593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669593600000",
    "number": "1396455754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 ATWATER RD",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317948513",
            "telephone_number": "229-392-6922",
            "fax_number": "855-565-1769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 TIFT AVE N STE B",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943577",
            "telephone_number": "229-396-5644",
            "fax_number": "855-565-1769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "HOLLY",
        "middle_name": "GEORGIANA",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-28",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "GA",
            "license": "OTA002554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@ontoptherapy.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "webmail",
            "address_1": "1401 Tift Ave N Ste B",
            "city": "Tifton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "317943577",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Monarch Room Mental Health LLC
• Floyd Jackson Moon II, PHARMD
• Moon's Pharmacy LTC (Moon's Pharmacy Inc)
• Alexandra Rose Moore
• Frederick Haygood Moore
• Jessica Nichole Moore, FNP-C
• Jody Ann Moore
• Linda Moore, RD
• Stacey Moore
• Brandi Moorman, FNP-C

• Occupational Therapy Assistant in Tifton, GA
• Providers in Tifton, GA by specialty
• Occupational Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; 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.