Provider Demographics
NPI:1194596254
Name:MOONBEAM THERAPIES PLLC
Entity type:Organization
Organization Name:MOONBEAM THERAPIES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:IRVIN
Authorized Official - Last Name:CRANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:334-865-2002
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-0310
Mailing Address - Country:US
Mailing Address - Phone:336-971-4734
Mailing Address - Fax:336-828-0124
Practice Address - Street 1:6609 SPRINGFIELD VILLAGE LN
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8996
Practice Address - Country:US
Practice Address - Phone:336-865-2002
Practice Address - Fax:336-828-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty