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General NPI Number Information
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NPI Number | 1447657168
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Entity Type | Individual
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Provider Name | MRS. HALEY OGNENOVSKI
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Gender | Female
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 401 LONG ST
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City | MENDON
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State | MO
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Zip | 64660-8108
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Country | US
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Telephone | 660-734-8146
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Fax |
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Provider Business Mailing Address
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Address Line | 401 LONG ST
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City | MENDON
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State | MO
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Zip | 64660-8108
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Country | US
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Telephone | 660-734-8146
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 2014001724
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License Number State | MO
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