MEDICARE: DONNA M TUNNELL OTR

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	2008025343	MO

General Provider Information

NPI Number	:	1396995882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA M TUNNELL OTR

Provider Business Mailing Address
First Line	:	233 S CEDAR CIR
Second Line	:
City	:	WEBB CITY
State	:	MO
Zip	:	64870-2053
Country	:	US
Telephone Number	:	651-366-7379
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 S CEDAR CIR
Second Line	:
City	:	WEBB CITY
State	:	MO
Zip	:	64870-2053
Country	:	US
Telephone Number	:	651-366-7379
Fax Number	:

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

Provider Enumeration Date	:	09/22/2008
Last Update Date	:	06/13/2011

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