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General NPI Number Information
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NPI Number | 1881975449
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Entity Type | Individual
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Provider Name | PERSIS RUPAMATHY BASKARAN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/08/2011
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Last Update Date | 09/08/2011
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Provider Practice Location Address
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Address Line | 1201 HUNT AVE
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City | COLUMBIA
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State | MO
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Zip | 65202-1367
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Country | US
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Telephone | 573-449-1448
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Fax |
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Provider Business Mailing Address
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Address Line | 701 WINDERMERE DR
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City | COLUMBIA
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State | MO
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Zip | 65203-6424
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Country | US
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Telephone | 573-673-3321
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 004071
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License Number State | MO
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