Provider Demographics
NPI:1144734641
Name:MOORE, MAKENZIE BRIDGETTE
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:BRIDGETTE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BURROUGHS RD
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-1515
Mailing Address - Country:US
Mailing Address - Phone:781-738-0213
Mailing Address - Fax:
Practice Address - Street 1:35 BURROUGHS RD
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-1515
Practice Address - Country:US
Practice Address - Phone:781-738-0213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist