Brian Keith Moran, OTA

Individual provider Active NPI Occupational Therapy Assistant · Marlow, OK

NPI 1497378442 · NPPES record last updated May 26, 2020

Key facts

NPI
1497378442
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
850 (OK)
Practice address
231 W Main St
Marlow, OK 73055-2439
Phone
(580) 721-7100
NPI assigned
May 26, 2020
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

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

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Rock Health and Wellness LLC Past
since May 31, 2020
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 850 OK Yes

Addresses

Primary practice location

231 W Main St
Marlow, OK 73055-2439

Mailing address

231 W Main St
Marlow, OK 73055-2439
Phone (580) 721-7100

Other identifiers

IdentifierTypeStateIssuer
OTHEROtherOTHER

Other providers in Marlow, OK

All providers in Marlow, OK · Occupational Therapy Assistant in Oklahoma

Sources for this page

Verify at the official NPI Registry.