Individual
ELIZABETH CHRISTINE COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1720 VIETH DR, JEFFERSON CITY, MO 65109-2056
(573) 635-6193
Mailing address
909 OWEN POINT RD, CAMDENTON, MO 65020-2520
(314) 315-0880
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2013021532
MO
Other
Enumeration date
02/03/2020
Last updated
02/03/2020
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