Individual
MANDISA PETTIFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
17134 BEL RAY PL, BELTON, MO 64012-5331
(816) 318-0436
(816) 318-0437
Mailing address
17134 BEL RAY PL, BELTON, MO 64012-5331
(816) 318-0436
(816) 318-0437
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2011006042
MO
Other
Enumeration date
01/07/2011
Last updated
10/25/2012
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