Chloe Waggoner
Individual provider Active NPI Occupational Therapy Assistant · Deepwater, MO
NPI 1831957679 · NPPES record last updated Mar 7, 2024
Key facts
- NPI
- 1831957679
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 2022007784 (MO)
- Practice address
- 12530 Lakeland School Dr
Deepwater, MO 64740-8138 - Phone
- (417) 644-2223
- NPI assigned
- Mar 7, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 2022007784 | MO | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeland R-III School District | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 2022007784 | MO | Yes |
Addresses
Primary practice location
12530 Lakeland School Dr
Deepwater, MO 64740-8138
Mailing address
2226 W Olive St
Springfield, MO 65802-4552
Other providers in Deepwater, MO
All providers in Deepwater, 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 Mar 7, 2024. 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.