Organization
MACON COUNTY R-1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOYCE M WILSON (SPECIAL SERVICES COORDINATOR)
(660) 385-5719
Entity
Organization
Contact information
Practice address
702 N MISSOURI ST, MACON, MO 63552-2062
(660) 385-5719
(660) 385-7179
Mailing address
702 N MISSOURI ST, MACON, MO 63552-2062
(660) 385-5719
(660) 385-7179
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
506094309
—
MO
Enumeration date
04/13/2007
Last updated
06/14/2016
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