Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 002360 | MO |
NPI | 1003220914 |
---|---|
Provider Name | Mary Thomas |
First Address | Blue Springs, MO 64014-2351 |
Second Address | Blue Springs, MO 64014-2351 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2014 |
Last Update Date | 18/06/2014 |