Provider Demographics
NPI:1043407216
Name:MOODY, SARAH HOUCHIN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:HOUCHIN
Last Name:MOODY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 ALBEMARLE DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-1572
Mailing Address - Country:US
Mailing Address - Phone:270-202-8808
Mailing Address - Fax:
Practice Address - Street 1:840 ALBEMARLE DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-1572
Practice Address - Country:US
Practice Address - Phone:270-202-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R2132225X00000X
KY132737225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist