Provider Demographics
NPI:1871076331
Name:MOORE, VALERIE NICOLE (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:NICOLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 LIBERTY RD. #103
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784
Mailing Address - Country:US
Mailing Address - Phone:410-598-4336
Mailing Address - Fax:
Practice Address - Street 1:2028 LIBERTY RD. #103
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784
Practice Address - Country:US
Practice Address - Phone:410-598-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2023-04-14
Deactivation Date:2022-12-13
Deactivation Code:
Reactivation Date:2023-04-13
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X106S00000X
MD09955225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician