Provider Demographics
NPI:1235535972
Name:MOODY, JAMES L (OT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:L
Last Name:MOODY
Suffix:
Gender:M
Credentials:OT
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Mailing Address - Street 1:305 NE LOOP 820
Mailing Address - Street 2:BUSINESS TOWER 1 SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7209
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:6800 PARK TEN BLVD
Practice Address - Street 2:SUITE 246-EAST
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4211
Practice Address - Country:US
Practice Address - Phone:210-377-3742
Practice Address - Fax:210-377-3744
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX110644225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist