417 Pediatric Therapy
NPI #1366106601 in Carl Junction, Missouri
Provider Information
- NPI Number
- 1366106601
- Entity Type
- Organization
- Organization Name
- 417 Pediatric Therapy
- Primary Specialty
- Occupational Therapist
- Enumeration Date
- Oct 22, 2021
- Last Updated
- Oct 22, 2021
Practice Location
- Address
- 420 RUBY RD
- City
- Carl Junction
- State
- Missouri
- ZIP Code
- 64834-8449
- Phone
- (417) 438-2244
Authorized Official
- Name
- LISA ELLEN SHALLENBURGER, OTR/L
- Title
- OCCUPATIONAL THERAPIST
- Phone
- (417) 438-2244
Specialties & Taxonomy Codes
| Specialty |
|---|
| Occupational Therapist |
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