Individual
KIMBERLY VANDIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
4087 W FOUNTAIN RD, JOPLIN, MO 64801-7686
(417) 389-9165
Mailing address
4087 W FOUNTAIN RD, JOPLIN, MO 64801-7686
(417) 389-9165
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
18-01310
KS
Other
Enumeration date
03/26/2017
Last updated
03/26/2017
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