Provider Demographics
NPI:1053565697
Name:MOYER, JOHN W (OTR/L)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:MOYER
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 WILLOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-6601
Mailing Address - Country:US
Mailing Address - Phone:717-764-8013
Mailing Address - Fax:
Practice Address - Street 1:2400 KINGSTON CT
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-3650
Practice Address - Country:US
Practice Address - Phone:717-755-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002241L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist