Individual
MARCY LYNETTE DEATHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3380
Mailing address
16816 W 83RD TER, LENEXA, KS 66219-8072
(913) 438-3372
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
004189
MO
Other
Enumeration date
11/01/2006
Last updated
07/08/2007
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