Provider Demographics
NPI:1265512107
Name:HOWDAHL, JODY DIANE (THERAPIST ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:DIANE
Last Name:HOWDAHL
Suffix:
Gender:F
Credentials:THERAPIST ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3238 WEST GREENWOOD APT B
Mailing Address - Street 2:
Mailing Address - City:SPRING FIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807
Mailing Address - Country:US
Mailing Address - Phone:417-885-8019
Mailing Address - Fax:
Practice Address - Street 1:2800 S FORT AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-882-0035
Practice Address - Fax:417-882-0103
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004729224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant