Individual
LICATA JEANE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
210 DAVIS DR, WEST PLAINS, MO 65775-2241
(417) 256-2152
Mailing address
210 DAVIS DR, WEST PLAINS, MO 65775-2241
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2008023618
MO
Other
Enumeration date
02/07/2013
Last updated
02/07/2013
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