Healthcare Provider Details

I. General information

NPI: 1942450200
Provider Name (Legal Business Name): MARJORIE MAE MCKEE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S CEDAR DR
STRAFFORD MO
65757-8308
US

IV. Provider business mailing address

101 S CEDAR DR
STRAFFORD MO
65757-8308
US

V. Phone/Fax

Practice location:
  • Phone: 417-736-3880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number115553
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: