Organization
REPUBLIC R-III
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KILINA GOLDENBERG (DISTRICT COORDINATOR)
(417) 732-3605
Entity
Organization
Contact information
Practice address
518 N HAMPTON AVE, REPUBLIC, MO 65738-1323
(417) 732-3605
(417) 732-3609
Mailing address
518 N HAMPTON AVE, REPUBLIC, MO 65738-1323
(417) 732-3605
(417) 732-3609
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
—
506157403
—
MO
Enumeration date
02/06/2007
Last updated
06/15/2016
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