Individual
DESTINY ALMAJO MABEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1101 W CLAY RD, VERSAILLES, MO 65084-1177
(573) 539-3065
Mailing address
1503 INDEPENDENCE RD, ROLLA, MO 65401-2639
(573) 368-8559
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2022010499
MO
Other
Enumeration date
04/12/2022
Last updated
04/12/2022
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