Misty Dace
Individual provider Active NPI Occupational Therapy Assistant · Marshall, MO
NPI 1407102494 · NPPES record last updated Jul 27, 2012
Key facts
- NPI
- 1407102494
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 2012004322 (MO)
- Practice address
- 1076 S English Ave
Marshall, MO 65340-2614 - Phone
- (660) 815-2463
- NPI assigned
- Jul 27, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2012004322 | MO | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 2012004322 | MO | Yes |
Addresses
Primary practice location
1076 S English Ave
Marshall, MO 65340-2614
Mailing address
1076 S English Ave
Marshall, MO 65340-2614
Other providers in Marshall, MO
- Justin Scot Cortez
- Curators of the University of Missouri
- Curators of the University of Missouri
- Jana Curry
- D. J. Fahnestock, D. C., P. C.
- Lyndsey Brooke Davis
- Dennis Leon Hunter
- Brian Devivo
- Carol S Dickerson
- Jeffery C Diehl
All providers in Marshall, MO · Occupational Therapy Assistant in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.