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General NPI Number Information
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NPI Number | 1851891709
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Entity Type | Individual
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Provider Name | JILL DEAN
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Gender | Female
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 35629 HIGHWAY 72
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City | SALEM
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State | MO
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Zip | 65560-7217
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Country | US
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Telephone | 972-457-1069
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 207
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City | NEW MELLE
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State | MO
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Zip | 63365-0207
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Country | US
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Telephone | 636-634-0006
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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 | 2012039673
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License Number State | MO
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