Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 005462 | MO |
NPI | 1013278183 |
---|---|
Provider Name | Miss Faith Eileen Dowell |
First Address | Saint Louis, MO 63137-1358 |
Second Address | Florissant, MO 63033-7204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2012 |
Last Update Date | 05/06/2012 |