Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Otha Moore

Individual provider Exclusive Provider Organization · NPI 1275902132

Mr. Otha Moore is an Exclusive Provider Organization in Southfield, Michigan. Practices as a sole proprietor. Licensed in Michigan.

Licensed in
MI
In the registry since
2015

Practice location Address checks out

18430 Westhampton
Southfield, MI 48075
Phone: (313) 844-1496
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Exclusive Provider Organization (primary) Taxonomy 302F00000X · Licence 7153185 (MI)

Record details

NPI number1275902132
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedSeptember 22, 2015
Last updated in NPPESSeptember 22, 2015

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