Provider Demographics
NPI:1710642210
Name:MOODY, SARAH JENNINGS (OTR/L)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JENNINGS
Last Name:MOODY
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:108 HEATHER GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2001
Mailing Address - Country:US
Mailing Address - Phone:478-893-6544
Mailing Address - Fax:
Practice Address - Street 1:1013 MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-4313
Practice Address - Country:US
Practice Address - Phone:478-224-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008231225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist