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General NPI Number Information
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NPI Number | 1063606408
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Entity Type | Individual
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Provider Name | GINGER R NEILL BUNDY COTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 1201 S POLK ST
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City | MAYSVILLE
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State | MO
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Zip | 64469-4028
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Country | US
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Telephone | 816-449-2281
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Fax | 816-449-2281
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Provider Business Mailing Address
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Address Line | 1201 S POLK ST
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City | MAYSVILLE
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State | MO
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Zip | 64469-4028
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Country | US
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Telephone | 816-449-2281
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Fax | 816-449-2281
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 2006025510
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License Number State | MO
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