=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821131889
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEELYVILLE R-4 SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 06/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 289 BROADWAY ST
-----------------------------------------------------
City | NEELYVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-989-3813
-----------------------------------------------------
Fax | 573-989-3434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8 289 BROADWAY ST
-----------------------------------------------------
City | NEELYVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63954-0008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-989-3813
-----------------------------------------------------
Fax | 573-989-3434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF STUDENT SERVICES
-----------------------------------------------------
Name | SABRINA MOREHEAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 573-989-3813
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------