Audrey Holtmeyer

Individual provider Active NPI Occupational Therapy Assistant · Vienna, MO

NPI 1487286183 · NPPES record last updated Feb 11, 2020

Key facts

NPI
1487286183
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
2016003644 (MO)
Practice address
174 Ballpark Rd
Vienna, MO 65582-8043
Phone
(573) 422-3177
NPI assigned
Feb 10, 2020
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

LicenseStateTypeSpecialty
2016003644MOMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant
Group: 193400000X SINGLE SPECIALTY GROUP
224Z00000X 2016003644 MO Yes

Addresses

Primary practice location

174 Ballpark Rd
Vienna, MO 65582-8043

Mailing address

452 Highway a
Iberia, MO 65486-8207
Phone (573) 645-8751

Other providers in Vienna, MO

All providers in Vienna, MO · Occupational Therapy Assistant in Missouri

Sources for this page

Verify at the official NPI Registry.