Provider Demographics
NPI:1760166623
Name:MOODY, EMMA CATHERINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:CATHERINE
Last Name:MOODY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:EMMA
Other - Middle Name:CATHERINE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2530 GENOA WAY APT 113
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-7019
Mailing Address - Country:US
Mailing Address - Phone:334-318-2338
Mailing Address - Fax:
Practice Address - Street 1:3140 CAHABA HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-5243
Practice Address - Country:US
Practice Address - Phone:205-969-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6095225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics