Individual
SAMUEL BRANDT PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT, MOT
Contact information
Practice address
678 S COMMERCIAL ST, HARRISONVILLE, MO 64701-1653
(816) 380-3325
(816) 380-3044
Mailing address
1200 CORPORATE DR STE 400, HOOVER, AL 35242-5424
(423) 238-7217
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
16730
CA
225X00000X
Occupational Therapist
Primary
2021023073
MO
225X00000X
Occupational Therapist
363945
—
Other
Enumeration date
09/09/2016
Last updated
06/18/2021
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