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Individual

THERESA MAE EVANS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
303 N LEE, LEETON, MO 64761
(660) 221-4281
Mailing address
PO BOX 195, 303 N LEE, LEETON, MO 64761
(660) 221-4281

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2012001563
MO

Other

Enumeration date
02/06/2017
Last updated
02/06/2017
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