Individual
TAMARA IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
702 MAIN ST, DE KALB, MO 64440-9634
(816) 450-8595
Mailing address
702 MAIN ST, DE KALB, MO 64440-9634
(816) 450-8595
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
004933
MO
Other
Enumeration date
12/20/2007
Last updated
12/20/2007
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