Individual
DUNCAN PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MOT, OTR/L
Contact information
Practice address
2612 S JACKSON AVE, JOPLIN, MO 64804-2520
(417) 592-9222
Mailing address
2612 S JACKSON AVE, JOPLIN, MO 64804-2520
(417) 592-9222
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2006002992
MO
Other
Enumeration date
12/07/2020
Last updated
12/07/2020
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