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General NPI Number Information
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NPI Number | 1083786586
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Entity Type | Organization
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Legal Business Name | SCHOOL OF THE OSAGE R-II
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 1501 SCHOOL ROAD
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City | LAKE OZARK
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State | MO
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Zip | 65049-1960
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Country | US
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Telephone | 573-365-4091
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Fax | 573-365-5748
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Provider Business Mailing Address
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Address Line | PO BOX 1960
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City | LAKE OZARK
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State | MO
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Zip | 65049-1960
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Country | US
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Telephone | 573-365-4091
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Fax | 573-365-5748
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | DR. MARY ANN JOHNSON
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Credential |
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Telephone | 573-365-4091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 503777302
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License Number State | MO
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