Organization
417 PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA ELLEN SHALLENBURGER OTR/L (OCCUPATIONAL THERAPIST)
(417) 438-2244
Entity
Organization
Contact information
Practice address
420 RUBY RD, CARL JUNCTION, MO 64834-8449
(417) 438-2244
Mailing address
420 RUBY RD, CARL JUNCTION, MO 64834-8449
(417) 438-2244
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
10/22/2021
Last updated
10/22/2021
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