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Individual

MS. SUSAN ASHLEY DURHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
C.O.T.A

Contact information

Practice address
276 FOUNTAIN LN, KIMBERLING CITY, MO 65686-9356
(417) 739-2481
Mailing address
213 MICAHS XING, REEDS SPRING, MO 65737-9787
(417) 272-0393

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2005023369
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2005023369
STATE LICENSURE NUMBER FOR OCCUPATIONAL THERAPY ASSISTANT
MO
Enumeration date
08/04/2008
Last updated
08/04/2008
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