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Individual

ABBY GRACE KOOPMANN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
612 BLUMHOFF AVE, WENTZVILLE, MO 63385-1104
(636) 697-3399
Mailing address
450 HIMMEL RD, MOSCOW MILLS, MO 63362-1810

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2021046337
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2021046337
LICENSE NUMBER
MO
Enumeration date
11/22/2021
Last updated
11/22/2021
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