Provider Demographics
NPI:1588833776
Name:MOODALY, KALAIVANI (OTR/L)
Entity Type:Individual
Prefix:
First Name:KALAIVANI
Middle Name:
Last Name:MOODALY
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 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-357-9380
Mailing Address - Fax:425-357-9382
Practice Address - Street 1:2800 NORTHUP WAY
Practice Address - Street 2:#200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1440
Practice Address - Country:US
Practice Address - Phone:425-827-5877
Practice Address - Fax:425-827-5843
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002234225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0277MOOtherREGENCE
WA9260MOOtherREGENCE
WA0122MOOtherREGENCE
WA0279MOOtherREGENCE
WA0257871OtherL&I
WA0278MOOtherREGENCE
WA0444MOOtherREGENCE
WA0268161OtherDEPT OF L&I
WAG8896208Medicare PIN
WA0277MOOtherREGENCE
WA0257871OtherL&I