Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 00089 | MO |
NPI | 1093741431 |
---|---|
Provider Name | Debra Kim Haberman |
First Address | Rolla, MO 65402-1629 |
Second Address | Rolla, MO 65401-3350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 14/07/2015 |