Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 000491 | MO |
NPI | 1053538231 |
---|---|
Provider Name | Karyn A Pemberton |
First Address | Kirkwood, MO 63122-2815 |
Second Address | Saint Louis, MO 63101-1015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |