Individual
DEANNA ELIZABETH WILDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1302 W SUNSET ST, SPRINGFIELD, MO 65807-5943
(417) 718-1085
Mailing address
649 S OAK GROVE AVE, SPRINGFIELD, MO 65802-2829
(417) 718-1085
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2017005627
MO
Other
Enumeration date
07/14/2017
Last updated
07/14/2017
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