Provider Demographics
NPI:1356967301
Name:MOSELEY, SARAH CAMILLE (OTR/L, MD)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:CAMILLE
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:OTR/L, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1416
Mailing Address - Country:US
Mailing Address - Phone:502-795-5189
Mailing Address - Fax:
Practice Address - Street 1:1924 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1416
Practice Address - Country:US
Practice Address - Phone:502-795-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYN20R00190101225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist