Healthcare Provider Details

I. General information

NPI: 1508774258
Provider Name (Legal Business Name): CITLLALY HARO-CUNDIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 GREENWOOD RD
CHESTNUTRIDGE MO
65630-3059
US

IV. Provider business mailing address

352 GREENWOOD RD
CHESTNUTRIDGE MO
65630-3059
US

V. Phone/Fax

Practice location:
  • Phone: 417-551-1168
  • Fax:
Mailing address:
  • Phone: 417-551-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2026010944
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: