Individual
MRS. KATHERYN KELLY MADDOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR L
Contact information
Practice address
525 N KEENE ST, SUITE 101, COLUMBIA, MO 65201-6967
(573) 882-7350
Mailing address
2606 GRANT LN, COLUMBIA, MO 65203-0652
(573) 819-1633
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
005250
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
474003928
—
MO
Enumeration date
11/30/2006
Last updated
05/01/2017
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