Individual
NATHAN RYAN RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3980 E JACKSON DR, INDEPENDENCE, MO 64057-2205
(816) 195-1433
Mailing address
508 17TH AVE S, GREENWOOD, MO 64034-9701
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2017022264
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
385891
NBCOT
—
Enumeration date
10/17/2017
Last updated
10/17/2017
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