Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 055096 | MO |
NPI | 1023352622 |
---|---|
Provider Name | Ms. Janet Sue O'neal |
First Address | Warsaw, MO 65355-0383 |
Second Address | Cameron, MO 64429-2005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2012 |
Last Update Date | 20/11/2012 |