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General NPI Number Information
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NPI Number | 1578681607
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Entity Type | Organization
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Legal Business Name | BOLIVAR R0I
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 604 W JACKSON ST
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City | BOLIVAR
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State | MO
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Zip | 65613-1904
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Country | US
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Telephone | 417-326-3811
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Fax |
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Provider Business Mailing Address
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Address Line | 604 W JACKSON ST
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City | BOLIVAR
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State | MO
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Zip | 65613-1904
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Country | US
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Telephone | 417-326-3811
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Fax |
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Authorized Official
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Title or Position | SPEECH THERAPIST
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Name | MS. TAMARA LYNN DAUGHTREY
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Credential |
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Telephone | 417-326-3811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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