Healthcare Provider Details

I. General information

NPI: 1952163321
Provider Name (Legal Business Name): LINDA MARIE LAIR RRT, RPFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5642 N HILARY CT
COLUMBIA MO
65202-9686
US

IV. Provider business mailing address

5642 N HILARY CT
COLUMBIA MO
65202-9686
US

V. Phone/Fax

Practice location:
  • Phone: 314-520-7667
  • Fax:
Mailing address:
  • Phone: 131-452-0766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number100707
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: