Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 2004018744 | MO |
NPI | 1497736953 |
---|---|
Provider Name | Mrs. Kelli Michelle Howard |
First Address | Ozark, MO 65721-4241 |
Second Address | Springfield, MO 65804-2203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 08/07/2007 |