Individual
MRS. MITZI MICHELLE CLEARY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
18939 EVERGREEN DR, COUNTRY CLUB, MO 64505-4058
(816) 279-3020
(816) 279-3094
Mailing address
18939 EVERGREEN DR, COUNTRY CLUB, MO 64505-4058
(816) 279-3020
(816) 279-3094
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
17-02329
KS
225X00000X
Occupational Therapist
Primary
2003000911
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
711037536
EMPLOYMENT IDENTIFICATION NUMBER
MO
Enumeration date
09/13/2006
Last updated
12/07/2010
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