MEDICARE: MRS. HOLLY CHRISTA MCDANNOLD M.S., OTR L

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2001000030	MO

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	:	1346396900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY CHRISTA MCDANNOLD M.S., OTR L

Provider Business Mailing Address
First Line	:	10331 MEADOW WOOD CT
Second Line	:
City	:	PRAIRIE HOME
State	:	MO
Zip	:	65068-2334
Country	:	US
Telephone Number	:	573-268-4351
Fax Number	:

Provider Business Practice Location Address
First Line	:	10331 MEADOW WOOD CT
Second Line	:
City	:	PRAIRIE HOME
State	:	MO
Zip	:	65068-2334
Country	:	US
Telephone Number	:	573-268-4351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	05/20/2011

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