Individual
KIMBERLY DEGENNARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11 W 14TH ST, CARROLLTON, MO 64633-1926
(816) 830-2272
Mailing address
11 W 14TH ST, CARROLLTON, MO 64633-1926
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2005002204
MO
225X00000X
Occupational Therapist
OT16686
FL
Other
Enumeration date
11/21/2014
Last updated
11/21/2014
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