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General NPI Number Information
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NPI Number | 1811804545
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Entity Type | Individual
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Provider Name | MCKENZIE JADE CROFFORD
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Gender | Female
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Dates
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Enumeration Date | 08/26/2026
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Last Update Date | 08/26/2026
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Provider Practice Location Address
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Address Line | 2240 COUNTY ROAD 1270
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City | WILLOW SPRINGS
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State | MO
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Zip | 65793-3393
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Country | US
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Telephone | 573-883-6761
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Fax |
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Provider Business Mailing Address
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Address Line | 2423 COVINGTON MDWS
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-2415
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Country | US
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Telephone | 573-707-0071
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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 | 2026011462
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License Number State | MO
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