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General NPI Number Information
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NPI Number | 1952429896
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Entity Type | Individual
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Provider Name | BETH MARSHALL OTR
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 902 INDEPENDENCE DR
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City | BOWLING GREEN
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State | MO
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Zip | 63334-2430
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Country | US
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Telephone | 573-324-3257
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Fax |
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Provider Business Mailing Address
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Address Line | 21 COLGATE CIR
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City | O FALLON
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State | MO
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Zip | 63366-3432
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Country | US
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Telephone | 636-978-2060
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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 | 2005029728
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License Number State | MO
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