Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 003149 | MO |
N | 224Z00000X | Occupational Therapy Assistant | 1517 | CA |
N | 224Z00000X | Occupational Therapy Assistant | 210437 | TX |
NPI | 1003045642 |
---|---|
Provider Name | Jacqueline Foote |
First Address | Butler, MO 64730-1130 |
Second Address | Humansville, MO 65674-8507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2009 |
Last Update Date | 03/07/2009 |