Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2010034176 | MO |
NPI | 1487908521 |
---|---|
Provider Name | Ms. Abby Lynn Mell |
First Address | Farmington, MO 63640-2910 |
Second Address | Farmington, MO 63640-8102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2012 |
Last Update Date | 02/11/2012 |