Individual
AMY VANDAVEER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
403 W MAIN ST, COLE CAMP, MO 65325-1144
(660) 668-4515
Mailing address
3105 BLUFF CREEK DR, COLUMBIA, MO 65201-3529
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2014003564
MO
Other
Enumeration date
11/17/2014
Last updated
11/17/2014
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