Healthcare Provider Details

I. General information

NPI: 1821331406
Provider Name (Legal Business Name): DWANALI SPERMAN MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 N STATE HIGHWAY CC
NIXA MO
65714-8015
US

IV. Provider business mailing address

109 BRIARCLIFF RD
BRANSON MO
65616-3735
US

V. Phone/Fax

Practice location:
  • Phone: 417-725-5774
  • Fax:
Mailing address:
  • Phone: 417-619-3466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2013000055
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: