Healthcare Provider Details

I. General information

NPI: 1386779973
Provider Name (Legal Business Name): DEBORAH L BUA MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH L ROWLAND

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 E STATE ROUTE 350
RAYTOWN MO
64138-2367
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 816-737-5502
  • Fax: 816-737-5504
Mailing address:
  • Phone: 816-226-4011
  • Fax: 816-524-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2006011923
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-01557
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: