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Individual
THOMAS JAMES MOODIE
Active
Individual
THOMAS JAMES MOODIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6766-26
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6766-26
WISCONSIN DSPS OCCUPATIONAL THERAPY LICENSE
WI
Enumeration date
04/24/2020
Last updated
04/24/2020
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