Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 001013 | MO |
NPI | 1255487948 |
---|---|
Provider Name | Mrs. Lynne Anne White |
First Address | Jefferson City, MO 65109-6831 |
Second Address | Jefferson, MO 65102-1128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 08/07/2007 |