Healthcare Provider Details

I. General information

NPI: 1609690601
Provider Name (Legal Business Name): DIANA MARIE SLOAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 E REPUBLIC RD
SPRINGFIELD MO
65804-7209
US

IV. Provider business mailing address

1530 E ERIE ST APT B3061530
SPRINGFIELD MO
65804-4596
US

V. Phone/Fax

Practice location:
  • Phone: 417-882-1000
  • Fax:
Mailing address:
  • Phone: 417-316-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2019022657
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: