Individual
JENNIFER LOUISE MATTOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5100 S MAIN AVE, D202, SPRINGFIELD, MO 65810-7830
(254) 214-5777
Mailing address
5100 S MAIN AVE, D202, SPRINGFIELD, MO 65810-7830
(254) 214-5777
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2013030308
MO
Other
Enumeration date
05/05/2014
Last updated
05/05/2014
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