MEDICARE: LEXINGTON SCHOOL DIXT RV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist
4	251300000X	Local Education Agency (LEA)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275678823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEXINGTON SCHOOL DIXT RV

Provider Business Mailing Address
First Line	:	2323A HIGH SCHOOL DRIVE
Second Line	:
City	:	LEXINGTON
State	:	MO
Zip	:	64067-1499
Country	:	US
Telephone Number	:	660-259-4369
Fax Number	:	660-259-4992

Provider Business Practice Location Address
First Line	:	2323A HIGH SCHOOL DRIVE
Second Line	:
City	:	LEXINGTON
State	:	MO
Zip	:	64067-1499
Country	:	US
Telephone Number	:	660-259-4369
Fax Number	:	660-259-4992

Authorized Official
Title or Position	:	DISTRICT COORDINATOR
Name	:	KELLEY S NORBERG
Credential	:
Telephone Number	:	660-259-4369

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	06/14/2016

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Directions to “LEXINGTON SCHOOL DIXT RV ” Practice Location

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