Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 00001576 | WA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 2018032487 | MO |
NPI | 1184106239 |
---|---|
Provider Name | Hallie Dew Anderson |
First Address | Springfield, MO 65807-5913 |
Second Address | Springfield, MO 65807-5913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2018 |
Last Update Date | 05/09/2018 |