Organization
CRAWFORD CO R-II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKIE GORSUCH (DISTRICT COORDINATOR)
(573) 885-2534
Entity
Organization
Contact information
Practice address
1 WILDCAT PRIDE DR, CRAWFORD CO R-II, CUBA, MO 65453-1549
(573) 885-2534
(573) 885-3900
Mailing address
1 WILDCAT PRIDE DR, CUBA, MO 65453-1549
(573) 885-2534
(573) 885-3900
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
506075100
—
MO
Enumeration date
04/09/2007
Last updated
06/13/2016
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