Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 004524 | MO |
NPI | 1003036369 |
---|---|
Provider Name | Marilyn J Sunde |
First Address | Eldon, MO 65026-1581 |
Second Address | Eldon, MO 65026-1581 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2007 |
Last Update Date | 20/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
474764610 | (05) | MO |