Active NPI
Adric Moe
- Behavior Technician
- Port Orchard, WA
National Provider Identifier
1730853177
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- CB61179256
- Practice address
- 1950 Pottery Ave Ste 124
Port Orchard, WA 98366-2501 - Phone
- (360) 355-8969
- NPI assigned
- Aug 8, 2021
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | CB61179256 | WA | Primary |
Addresses
Primary practice location
1950 Pottery Ave Ste 124
Port Orchard, WA 98366-2501
Mailing address
2073 NE Old Belfair Hwy
Belfair, WA 98528-9657
Phone (154) 156-1453
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 |
|---|---|---|---|
| CB61179256 | WA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628380800000",
"number": "1730853177",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2073 NE OLD BELFAIR HWY",
"city": "BELFAIR",
"state": "WA",
"postal_code": "985289657",
"telephone_number": "154-156-1453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1950 POTTERY AVE STE 124",
"city": "PORT ORCHARD",
"state": "WA",
"postal_code": "983662501",
"telephone_number": "360-355-8969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOE",
"first_name": "ADRIC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-08-08",
"last_updated": "2021-08-08",
"certification_date": "2021-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "WA",
"license": "CB61179256",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Orchard, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.