Provider Demographics
NPI:1063041366
Name:MOATS, CARLA SUE
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:SUE
Last Name:MOATS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33244 CHARLTON DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-8470
Mailing Address - Country:US
Mailing Address - Phone:330-341-2002
Mailing Address - Fax:
Practice Address - Street 1:33244 CHARLTON DR UNIT B
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-8470
Practice Address - Country:US
Practice Address - Phone:330-341-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care