Individual
CARRIE JO TYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
111 NW MOCK AVE, BLUE SPRINGS, MO 64014-2503
(816) 220-4247
Mailing address
23543 W 74TH ST, SHAWNEE, KS 66227-5518
(785) 215-1896
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
2010025842
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2010025842
OUTPATIENT
MO
Enumeration date
06/23/2021
Last updated
06/23/2021
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