Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 057003825 | IL |
Y | 224Z00000X | Occupational Therapy Assistant | 2012019679 | MO |
NPI | 1023564804 |
---|---|
Provider Name | Deneishion Darby |
First Address | Florissant, MO 63034 |
Second Address | Ballwin, MO 63021-7818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2016 |
Last Update Date | 31/08/2016 |