Moore, Stacey L S

Moore, Stacey L S is an sole proprietor health care provider with primary practice located at 2895 Se Powell Valley Rd , Gresham OR 97080-1492. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, which is considered as her primary health care specialty. Moore, Stacey L S can be contacted via phone (971) 571-5319.

Contact Information

Primary practice address
2895 Se Powell Valley Rd Gresham OR 97080-1492
Phone: (971) 571-5319
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist 225X00000X OC-009631 Pennsylvania
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist 225X00000X 1073412 Oregon

Profile Details

NPI number 1558426593
LBN Legal business name Moore, Stacey L S
Credentials MOTR/L
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 27th, 2006
Last updated Sep 19th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558426593 NPPES
Pennsylvania MEDICAID 101847812 0001

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