Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 001176 | MO |
NPI | 1033422456 |
---|---|
Provider Name | Mrs. Elizabeth Criswell |
First Address | Raytown, MO 64133-3730 |
Second Address | Raytown, MO 64133-3730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2010 |
Last Update Date | 15/07/2010 |