Provider Demographics
NPI:1679159693
Name:MOOGALIAN, KACEY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KACEY
Middle Name:
Last Name:MOOGALIAN
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 1:3130 SHEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22801-2543
Mailing Address - Country:US
Mailing Address - Phone:540-746-8694
Mailing Address - Fax:
Practice Address - Street 1:1475 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-2433
Practice Address - Country:US
Practice Address - Phone:540-564-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119007261225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist