Provider Demographics
NPI:1811327141
Name:MOAT, ALICIA (OTR/L)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:MOAT
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 1:400 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2024
Mailing Address - Country:US
Mailing Address - Phone:740-373-3597
Mailing Address - Fax:740-376-0004
Practice Address - Street 1:400 N 7TH ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2024
Practice Address - Country:US
Practice Address - Phone:740-373-3597
Practice Address - Fax:740-376-0004
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5938225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology