Provider Demographics
NPI:1366726127
Name:MOORE, MARTYN
Entity type:Individual
Prefix:MS
First Name:MARTYN
Middle Name:
Last Name:MOORE
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 1:11875 SW 91ST AVE
Mailing Address - Street 2:#46
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6332
Mailing Address - Country:US
Mailing Address - Phone:503-620-7347
Mailing Address - Fax:
Practice Address - Street 1:11875 SW 91ST AVE
Practice Address - Street 2:#46
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6332
Practice Address - Country:US
Practice Address - Phone:503-620-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker