Individual
SUSAN PAULINE MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTAL
Contact information
Practice address
699 S PARK RD, CHARLESTON, WV 25304-2627
(304) 925-1532
(304) 925-8018
Mailing address
PO BOX 564, SOPHIA, WV 25921-0564
(304) 683-4867
(304) 925-8018
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C1358
WV
Other
Enumeration date
03/22/2007
Last updated
07/08/2007
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