Provider Demographics
NPI:1992049159
Name:MOORE, SUSAN LOUISE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LOUISE
Last Name:MOORE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 YELLOWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4611
Mailing Address - Country:US
Mailing Address - Phone:610-269-8223
Mailing Address - Fax:
Practice Address - Street 1:9 BRISTOL CT
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1851
Practice Address - Country:US
Practice Address - Phone:610-670-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007399224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant