Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1999139234 | MO |
NPI | 1013115179 |
---|---|
Provider Name | Doris M Smith |
First Address | Saint Peters, MO 63376-4612 |
Second Address | Saint Peters, MO 63376-4612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 10/07/2007 |