Individual
MRS. ELIZABETH MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
5709 POPLIN RD, INDIAN TRAIL, NC 28079-6727
(704) 628-6136
Mailing address
5709 POPLIN RD, INDIAN TRAIL, NC 28079-6727
(704) 628-6136
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
5280
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5280
NC BOARD OF OT LICENSE #
NC
05
—
7301704
—
NC
Enumeration date
10/25/2006
Last updated
12/20/2010
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