Provider Demographics
NPI:1235947904
Name:MOORE, SIMONE (OT)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 COLLYER ST APT 108
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5558
Mailing Address - Country:US
Mailing Address - Phone:303-667-1763
Mailing Address - Fax:855-678-8887
Practice Address - Street 1:348 COLLYER ST APT 108
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5558
Practice Address - Country:US
Practice Address - Phone:303-667-1763
Practice Address - Fax:855-678-8887
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0008087225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist