Individual
MARY JO WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
379 STATE ROAD MM, BUFFALO, MO 65622-8636
(417) 345-7779
Mailing address
379 STATE ROAD MM, BUFFALO, MO 65622-8636
(417) 345-7779
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2003024323
MO
Other
Enumeration date
07/06/2009
Last updated
07/06/2009
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