Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 00004569 | MO |
NPI | 1003017377 |
---|---|
Provider Name | Mrs. Heather Dawn Barnes |
First Address | Jefferson City, MO 65101-5227 |
Second Address | Jefferson City, MO 65101-5227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 08/07/2007 |