Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2017027428 | MO |
NPI | 1023520012 |
---|---|
Provider Name | Mary Cecelia Mcandrews |
First Address | Ballwin, MO 63021-8336 |
Second Address | Chesterfield, MO 63017-7048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2017 |
Last Update Date | 30/10/2017 |