Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2013001408 | MO |
NPI | 1003257676 |
---|---|
Provider Name | Kristin Jo Ainsworth |
First Address | Concordia, MO 64020-9373 |
Second Address | Concordia, MO 64020-9373 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2013 |
Last Update Date | 11/07/2013 |