Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2019007158 | MO |
NPI | 1023673654 |
---|---|
Provider Name | Lindsey Renee Mccoll |
First Address | Festus, MO 63028-3400 |
Second Address | Festus, MO 63028-3400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2019 |
Last Update Date | 09/05/2019 |