Individual
SANDRA RAE DIVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.A
Contact information
Practice address
1015 LANCASTER DR, STOCKTON, MO 65785-8360
(417) 276-4531
Mailing address
1015 LANCASTER DR, STOCKTON, MO 65785-8360
(417) 276-4531
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
115167
MO
Other
Enumeration date
12/15/2014
Last updated
12/15/2014
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