Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2013026311 | MO |
NPI | 1023439387 |
---|---|
Provider Name | Mrs. Jaime E Lile |
First Address | West Plains, MO 65775 |
Second Address | West Plains, MO 65775 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2014 |
Last Update Date | 03/01/2014 |