Individual
WILL DISTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1701 LACEY ST, CAPE GIRARDEAU, MO 63701-5230
(573) 334-4822
Mailing address
1701 LACEY ST, CAPE GIRARDEAU, MO 63701-5230
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2024038894
MO
Other
Enumeration date
11/14/2024
Last updated
11/14/2024
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