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General NPI Number Information
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NPI Number | 1134543168
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Entity Type | Individual
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Provider Name | KIM STEVENS RDH BS MBA OM
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Gender | Female
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Dates
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Enumeration Date | 02/11/2014
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Last Update Date | 02/11/2014
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Provider Practice Location Address
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Address Line | 3921 S 24TH ST
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City | QUINCY
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State | IL
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Zip | 62305-8925
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Country | US
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Telephone | 573-231-6385
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Fax |
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Provider Business Mailing Address
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Address Line | 3921 S 24TH ST
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City | QUINCY
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State | IL
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Zip | 62305-8925
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Country | US
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Telephone | 573-231-6385
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Fax |
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | 001181
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License Number State | MO
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