Individual
ERICA SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3023 S FORT AVE STE B, SPRINGFIELD, MO 65807-4217
(417) 890-4656
Mailing address
4417 S QUAIL CREEK AVE, SPRINGFIELD, MO 65810-1664
(417) 766-7372
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020000392
STATE LICENSE
MO
Enumeration date
07/07/2020
Last updated
07/07/2020
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