Basic Information
| Provider Information | |||||||||
| NPI: | 1124590823 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOULDER | ||||||||
| FirstName: | SARA | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4192 PALMETTO DR | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405131303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596845311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2050 VERSAILLES RD | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405041405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592545701 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2018 | ||||||||
| LastUpdateDate: | 12/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 175083 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.