Healthcare Provider Details

I. General information

NPI: 1851921076
Provider Name (Legal Business Name): STEPHANIE MARIE WOODS RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 WILKES BLVD
COLUMBIA MO
65201-4772
US

IV. Provider business mailing address

19700 S ROUTE A
HARTSBURG MO
65039-9732
US

V. Phone/Fax

Practice location:
  • Phone: 573-474-0560
  • Fax:
Mailing address:
  • Phone: 573-529-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: