Individual
MRS. JESSICA TANZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
400 N WATERS ST, PERRYVILLE, MO 63775-1750
(573) 768-4457
Mailing address
400 N WATERS ST, PERRYVILLE, MO 63775-1750
(573) 768-4457
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2009020516
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2009020516
OCCUPATIONAL THERAPIST LICENSE NUMBER
MO
Enumeration date
08/15/2014
Last updated
08/15/2014
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