Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 001911 | MO |
NPI | 1003093204 |
---|---|
Provider Name | Suzanne S Ervin |
First Address | Springfield, MO 65804-6412 |
Second Address | Springfield, MO 65804-6412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2008 |
Last Update Date | 17/08/2010 |