Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2006003744 | MO |
NPI | 1053486449 |
---|---|
Provider Name | Mrs. Tearsa Harlan |
First Address | Saint Jacob, IL 62281-1073 |
Second Address | Saint Louis, MO 63110-4025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |