Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XE0001X | Environmental Modification | 000424 | MO |
N | 225XF0002X | Feeding, Eating & Swallowing | 000424 | MO |
Y | 225XG0600X | Occupational Therapist - Gerontology | 000424 | MO |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 000424 | MO |
NPI | 1700149242 |
---|---|
Provider Name | Lisa Karen Holtmeyer |
First Address | Warrenton, MO 63383-4534 |
Second Address | Warrenton, MO 63383-4534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2012 |
Last Update Date | 20/06/2012 |