Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2010026041 | MO |
NPI | 1013293828 |
---|---|
Provider Name | Mr. Kelly Gene Jones |
First Address | Springfield, MO 65801-1374 |
Second Address | Humansville, MO 65674-8507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2011 |
Last Update Date | 25/10/2011 |