MEDICARE: MRS. JENNIFER L. KALYANGO

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	2003003153	MO

General Provider Information

NPI Number	:	1356419329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER L. KALYANGO

Provider Business Mailing Address
First Line	:	2690 US HIGHWAY 54
Second Line	:
City	:	KINGDOM CITY
State	:	MO
Zip	:	65262-0033
Country	:	US
Telephone Number	:	573-386-2214
Fax Number	:	573-386-2169

Provider Business Practice Location Address
First Line	:	2690 US HIGHWAY 54
Second Line	:
City	:	KINGDOM CITY
State	:	MO
Zip	:	65262-0033
Country	:	US
Telephone Number	:	573-386-2214
Fax Number	:	573-386-2169

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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