Individual
RAQUEL DESIREE MALLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8559 N LINE CREEK PKWY, KANSAS CITY, MO 64154-2100
(816) 468-2011
Mailing address
10908 W 66TH ST APT 303, SHAWNEE, KS 66203-3425
(816) 315-6583
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2016043316
MO
Other
Enumeration date
03/07/2017
Last updated
03/07/2017
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