Individual
REBECCA DIVYA JEYASEELAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
932 E 34TH ST, JOPLIN, MO 64804-3932
(417) 347-1111
Mailing address
PO BOX 3810, JOPLIN, MO 64803-3810
(417) 347-1111
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2013021428
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/11/2008
Last updated
11/26/2013
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