Basic Information
| Provider Information | |||||||||
| NPI: | 1588937650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOOERS | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S. OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 NORTH STREET | ||||||||
| Address2: | |||||||||
| City: | HOULTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075324093 | ||||||||
| FaxNumber: | 2075324718 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 HARTFORD ST | ||||||||
| Address2: | |||||||||
| City: | HOULTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047301891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075212262 | ||||||||
| FaxNumber: | 2075324718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2012 | ||||||||
| LastUpdateDate: | 02/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT431 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.