Individual
THOMAS JAMES MOODIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
400 WATER AVE, HILLSBORO, WI 54634-9054
(608) 489-8000
Mailing address
855 PANORAMA CT APT 313, RICHLAND CENTER, WI 53581-9217
(608) 335-9733
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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