Active NPI
Ryan C Moore
- Occupational Therapy Assistant
- Port Richey, FL
National Provider Identifier
1669024402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OTA14321
- Practice address
- 11736 Rolling Pine LN
Port Richey, FL 34668-1150 - Phone
- (352) 445-6671
- NPI assigned
- Jul 11, 2019
- Sex
- Male
- Sole proprietor
- No
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 | OTA14321 | FL | Primary |
Addresses
Primary practice location
11736 Rolling Pine LN
Port Richey, FL 34668-1150
Mailing address
11736 Rolling Pine LN
Port Richey, FL 34668-1150
Phone (352) 445-6671
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 |
|---|---|---|---|
| OTA14321 | FL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562803200000",
"number": "1669024402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11736 ROLLING PINE LN",
"city": "PORT RICHEY",
"state": "FL",
"postal_code": "346681150",
"telephone_number": "352-445-6671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11736 ROLLING PINE LN",
"city": "PORT RICHEY",
"state": "FL",
"postal_code": "346681150",
"telephone_number": "352-445-6671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "RYAN",
"middle_name": "C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-11",
"last_updated": "2019-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "FL",
"license": "OTA14321",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Richey, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.