Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2008010251 | MO |
NPI | 1023361334 |
---|---|
Provider Name | Mrs. Amanda Leann Hobson |
First Address | Springfield, MO 65802-2616 |
Second Address | Springfield, MO 65802-2616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2012 |
Last Update Date | 24/10/2012 |