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Individual

BROOKE WASHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
30325 FINE DR, LACLEDE, MO 64651-8102
(660) 734-8196
Mailing address
30325 FINE DR, LACLEDE, MO 64651-8102
(660) 734-8196

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2015018447
MO
224Z00000X
Occupational Therapy Assistant
213545
TX
224Z00000X
Occupational Therapy Assistant
81269
IA
224Z00000X
Occupational Therapy Assistant
986
NE

Other

Enumeration date
06/07/2016
Last updated
06/07/2016
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