Provider Demographics
NPI:1366563454
Name:MOODY, BARBARA GAYLE (OTR)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:GAYLE
Last Name:MOODY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 IMPERIAL DR W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-2221
Mailing Address - Country:US
Mailing Address - Phone:651-455-1031
Mailing Address - Fax:
Practice Address - Street 1:44 IMPERIAL DR W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-2221
Practice Address - Country:US
Practice Address - Phone:651-455-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102762225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist