Individual
KYLIE ELISE SHUMATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
908 WOOD ST, FULTON, MO 65251-2109
(573) 590-8400
Mailing address
6491 COUNTY ROAD 470, MOKANE, MO 65059-1303
(573) 550-8964
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2023018178
MO
Other
Enumeration date
12/18/2023
Last updated
12/18/2023
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