Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 2002012789 | MO |
NPI | 1366712853 |
---|---|
Provider Name | Ms. Merla Diesta Deo |
First Address | Warsaw, MO 65355-0383 |
Second Address | Saint James, MO 65559-1926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2011 |
Last Update Date | 30/12/2011 |