Healthcare Provider Details

I. General information

NPI: 1487803318
Provider Name (Legal Business Name): LINDA D TIBBETTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA TIBBETTS MS/OTR

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SEMINARY STREET
WARSAW MO
65355
US

IV. Provider business mailing address

30191 GREENWOOD DR
EDWARDS MO
65326-3050
US

V. Phone/Fax

Practice location:
  • Phone: 660-438-6993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2003007815
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: