Individual
MRS. OLIVIA DAWN KERNEBECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3119 VALLEY OAKS DR, IMPERIAL, MO 63052-4364
(636) 461-2761
Mailing address
3119 VALLEY OAKS DR, IMPERIAL, MO 63052-4364
(636) 461-2761
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
005428
MO
Other
Enumeration date
02/16/2007
Last updated
07/09/2007
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