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Kenneth Moore, ATC
NPI 1669409967 · on the registry since 2006
Practice
- Address
- 901 Lincoln Rd
Idabel, OK 74745 - Phone
- (580) 212-9785
Registry record
- Primary taxonomy
- 2255A2300X
2255A2300X
- Licence states on file
- OK
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2007-07-08
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Oklahoma