Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 2011008936 | MO |
Y | 225XH1200X | Occupational Therapist - Hand | 2011008936 | MO |
NPI | 1184012981 |
---|---|
Provider Name | Eliza Prager |
First Address | Columbia, MO 65201-7193 |
Second Address | Saint Louis, MO 63141-8704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2014 |
Last Update Date | 31/12/2014 |