Organization
FAYETTE R-III
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRI FLETCHER (DISTRICT COORDINATOR)
(660) 248-2153
Entity
Organization
Contact information
Practice address
705 LUCKY ST, FAYETTE, MO 65248-1140
(660) 248-2153
(660) 248-3702
Mailing address
705 LUCKY ST, FAYETTE, MO 65248-1140
(660) 248-2153
(660) 248-3702
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
—
506076009
—
MO
Enumeration date
04/13/2007
Last updated
06/13/2016
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