Provider Demographics
NPI:1124774237
Name:ANDINO, MORIAH GRACE
Entity type:Individual
Prefix:
First Name:MORIAH
Middle Name:GRACE
Last Name:ANDINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 TALMAGA LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9414
Mailing Address - Country:US
Mailing Address - Phone:336-580-1815
Mailing Address - Fax:
Practice Address - Street 1:4107 TALMAGA LN
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9414
Practice Address - Country:US
Practice Address - Phone:336-580-1815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist