Individual
AUTUMN BUSSELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
524 VILLAGE RD, PORT LAVACA, TX 77979-2380
(361) 552-3741
Mailing address
720 SIDNEY LN, WILLARD, MO 65781-7272
(417) 270-6695
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
216023
TX
Other
Enumeration date
07/20/2020
Last updated
07/20/2020
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