Individual
MR. MARTIN JAMES CONNELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
2415 SUNRISE DR, EUREKA, MO 63025-3512
(636) 938-6534
Mailing address
2415 SUNRISE DR, EUREKA, MO 63025-3512
(636) 938-6534
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
001454
MO
Other
Enumeration date
12/19/2006
Last updated
07/08/2007
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