Change Academy Lake Ozark

NPI #1528469772 in Lake Ozark, Missouri

Provider Information

NPI Number: 1528469772
Entity Type: Organization
Organization Name: Change Academy Lake Ozark
Primary Specialty: Clinic/Center
Enumeration Date: Sep 8, 2014
Last Updated: May 22, 2015

Practice Location

Address: 130 CALO LN
City: Lake Ozark
State: Missouri
ZIP Code: 65049-9208
Phone: (573) 365-2221

Authorized Official

Name: DENISE HAGEMANN
Title: OTR/L
Phone: (573) 552-8007

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Home Health	251E00000X
Early Intervention Provider Agency	252Y00000X
Preferred Provider Organization	305R00000X
Clinic/Center	261Q00000X	Primary

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