Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | ||
N | 225000000X | Orthotic Fitter |
NPI | 1932445095 |
---|---|
Provider Name | Tamera Newberry |
First Address | Imperial, MO 63052-3036 |
Second Address | Imperial, MO 63052-3036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2012 |
Last Update Date | 18/12/2012 |