Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2000143617 | MO |
N | 225XG0600X | Occupational Therapist - Gerontology | 2000143617 | MO |
NPI | 1285052019 |
---|---|
Provider Name | Lana Sheldon |
First Address | Osceola, MO 64776-6382 |
Second Address | Osceola, MO 64776-6382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2014 |
Last Update Date | 29/03/2014 |