Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 2015031466 | MO |
N | 225400000X | Rehabilitation Practitioner | ||
N | 225C00000X | Rehabilitation Counselor | ||
N | 225CA2400X | Assistive Technology Practitioner |
NPI | 1801156724 |
---|---|
Provider Name | Mrs. Carly Renae Elms |
First Address | Independence, MO 64050-1647 |
Second Address | Oak Grove, MO 64075-9406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2012 |
Last Update Date | 26/10/2016 |