Brendan Moore, B.A.
Individual provider Active NPI Occupational Therapist · Cedar Crest, NM
NPI 1407211345 · NPPES record last updated Mar 8, 2021
Key facts
- NPI
- 1407211345
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 2106 (NM)
- Practice address
- 12127 State Hwy 14 N
Cedar Crest, NM 87008-9461 - Phone
- (505) 286-3678
- NPI assigned
- Dec 18, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- University of New Mexico School of Medicine, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Fowler Enterprises Inc
Liveability LLC
Practice addresses (Care Compare)
12127 N Hwy 14 B-3
East Mountain PT
Cedar Crest, NM 87008-9462
Phone (505) 286-3678
9 Taylor Loop
Santa Fe, NM 87508-4509
Phone (505) 519-6932
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210601002587 | NM | Practitioner - Occupational Therapist in Private Practice | 1658770201 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Bachelor of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2106 | NM | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fowler Enterprises Inc | Current |
Accepting new patients | |
| Liveability LLC | Occupational Therapist | Current |
Accepting new patients |
Locations
12127 Highway 14 N
Ste B3
Cedar Crest, NM 87008
Phone (505) 286-3678
12127 N Highway 14
#B3E
Cedar Crest, NM 87008
Phone (505) 286-3678
1851 US Highway 66
Ste 2B
Edgewood, NM 87015
9 Taylor Loop
Santa Fe, NM 87508
Phone (505) 519-6932
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Counselor | 101YS0200X | |||
| Occupational Therapist | 225X00000X | 2106 | NM | Yes |
Addresses
Primary practice location
12127 State Hwy 14 N
Cedar Crest, NM 87008-9461
Mailing address
316 Wellesley Dr SE
Albuquerque, NM 87106-1422
Phone (808) 365-3931
Other providers in Cedar Crest, NM
- McLeod Medical Centers of NM, Inc.
- Orrin Kent McLeod
- Jennifer Alyx Medlock
- Sarah Messler
- Amy Beth Marie Miller
- Mountain Community Counseling
- Connor Murphy
- Alysandra Newbill
- Jaclyn M Oddi
- Optomeyes, Inc.
All providers in Cedar Crest, NM · Occupational Therapist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.