Organization
KIDDLY WINKS THERAPEUTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARISA G PURSELL (MANAGER)
(573) 587-6772
Entity
Organization
Contact information
Practice address
875 N KINGSHIGHWAY ST, SUITE B, CAPE GIRARDEAU, MO 63701-4315
(573) 587-6772
Mailing address
3140 LAUREL LN, CAPE GIRARDEAU, MO 63701-4108
(573) 587-6772
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2002014370
MO
Other
Enumeration date
07/17/2010
Last updated
07/17/2010
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