Provider Demographics
NPI:1235970203
Name:MOORE, KARLYN ANITRA (MT-BC)
Entity type:Individual
Prefix:
First Name:KARLYN
Middle Name:ANITRA
Last Name:MOORE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 COUNCIL ST APT 108
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0389
Mailing Address - Country:US
Mailing Address - Phone:619-616-1161
Mailing Address - Fax:
Practice Address - Street 1:636 COUNCIL ST APT 108
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0389
Practice Address - Country:US
Practice Address - Phone:737-867-9268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
18691225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist