Provider Demographics
NPI:1528484250
Name:MOORE, NORMA
Entity type:Individual
Prefix:
First Name:NORMA
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 1:505 W 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2028
Mailing Address - Country:US
Mailing Address - Phone:219-805-0867
Mailing Address - Fax:
Practice Address - Street 1:1120 S CALUMET RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-3285
Practice Address - Country:US
Practice Address - Phone:219-983-9675
Practice Address - Fax:219-983-9681
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist