Active NPI
Annette Moore
- Occupational Therapy Assistant
- Lucasville, OH
National Provider Identifier
1619216165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 01286
- Practice address
- 10098 Bear Creek Rd
Lucasville, OH 45648-9168 - Phone
- (740) 259-5536
- NPI assigned
- Feb 4, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 01286 | OH | Primary |
Addresses
Primary practice location
10098 Bear Creek Rd
Lucasville, OH 45648-9168
Mailing address
1235 Sarasue Ave
Portsmouth, OH 45662-6445
Phone (740) 353-5147
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01286 | OH | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lucasville I Facility Operations, LLC | Past | Accepting new patients | |
| Tandem Health Care of Lucasville I, Inc. | Past | Accepting new patients |
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.
-
- Skilled Nursing Facility
- Lucasville, OH
- NPI 1730103813
-
- Skilled Nursing Facility
- Lucasville, OH
- NPI 1972530392
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359936000000",
"number": "1619216165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1235 SARASUE AVE",
"city": "PORTSMOUTH",
"state": "OH",
"postal_code": "456626445",
"telephone_number": "740-353-5147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10098 BEAR CREEK RD",
"city": "LUCASVILLE",
"state": "OH",
"postal_code": "456489168",
"telephone_number": "740-259-5536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "ANNETTE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-02-04",
"last_updated": "2013-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "OH",
"license": "01286",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lucasville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.