=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912853789
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMMIE HUDDLE MOODY SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2026
-----------------------------------------------------
Last Update Date | 03/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4137 NC 73 HWY
-----------------------------------------------------
City | IRON STATION
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28080-7709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-732-0761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 JEB SEAGLE DR
-----------------------------------------------------
City | LINCOLNTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28092-2167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-736-1017
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 3481
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------