Provider Demographics
NPI:1639661515
Name:MOAT, ROBERT (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MOAT
Suffix:
Gender:M
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 1:601 MASONIC PARK RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1044
Mailing Address - Country:US
Mailing Address - Phone:740-336-3702
Mailing Address - Fax:
Practice Address - Street 1:160 GROSS ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2031
Practice Address - Country:US
Practice Address - Phone:740-374-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1940225X00000X
OHOT010082225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist