| Doctor Name: | SARAH MOORE |
| NPI Number: | 1063764322 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NYS TECHER CERT. |
| License Number: | 2271070 |
| Business Practice Address: | 555 Warren Rd Ithaca, NY - 148501862 |
| Business Phone Number: | 6072571551 |
| Business Fax Number: | |
| Mailing Address: | Po Box 223, BROOKTONDALE |
| State: | NY |
| Postal Code: | 148170223 |
| Phone Number: | 6072571551 |
| Fax Number: | |
| NPI Enumeration Date: | 10/11/2012 |
| NPI Last Update Date: | 10/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235500000X |
| License Number: | 2271070 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals who are trained on a specific piece of equipment or technical procedure. |