Healthcare Provider Details

I. General information

NPI: 1952183469
Provider Name (Legal Business Name): CHRISTYN E YEADON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MOCCASIN DR
WARRENTON MO
63383
US

IV. Provider business mailing address

3 MOCCASIN DR
WARRENTON MO
63383
US

V. Phone/Fax

Practice location:
  • Phone: 618-780-7667
  • Fax:
Mailing address:
  • Phone: 618-780-7667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2018012549
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: