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Organization
CHANGE ACADEMY LAKE OZARK
Active
Organization
CHANGE ACADEMY LAKE OZARK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE HAGEMANN (OTR/L)
(573) 552-8007
Entity
Organization
Contact information
Practice address
130 CALO LN, LAKE OZARK, MO 65049-9208
(573) 365-2221
(573) 365-2224
Mailing address
130 CALO LN, LAKE OZARK, MO 65049-9208
(573) 365-2221
(573) 365-2224
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
016604
MO
252Y00000X
Early Intervention Provider Agency
016604
MO
261Q00000X
Clinic/Center
Primary
016604
MO
305R00000X
Preferred Provider Organization
016604
MO
Other
Enumeration date
09/08/2014
Last updated
05/22/2015
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