Kelly Anne Moore, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

391117 Issued in OR

Practice address

14645 SW Farmington Rd
Beaverton, OR 97007-2727

Phone

(503) 643-8626

NPI assigned

Sep 22, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522627200000",
    "number": "1871002725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11761 NW BLACKHAWK DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972298807",
            "telephone_number": "503-778-0551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14645 SW FARMINGTON RD",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970072727",
            "telephone_number": "503-643-8626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30900 SW Parkway Ave",
            "address_purpose": "LOCATION",
            "city": "Wilsonville",
            "state": "OR",
            "postal_code": "970707835",
            "country_code": "US",
            "telephone_number": "503-682-2840",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KELLY",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-22",
        "last_updated": "2018-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "OR",
            "license": "391117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mattelynn Ellise Moon
• Courtney L Moore
• Elizabeth Adair Moore, AGPCNP-BC
• Jessica Moore, CRM
• Jessica C Moore
• Michal Sierra Moore, LPC
• Nikki Moore, RDH
• Steven Philip Moore
• Gelsca Desindia Morales Felix
• Vanessa Morales

• Occupational Therapist in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Occupational Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.