Provider Demographics
NPI:1356481295
Name:FREDERICKTOWN R-I SCHOOL DIST
Entity Type:Organization
Organization Name:FREDERICKTOWN R-I SCHOOL DIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-783-2570
Mailing Address - Street 1:704 E HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-7491
Mailing Address - Country:US
Mailing Address - Phone:573-783-2570
Mailing Address - Fax:573-783-7045
Practice Address - Street 1:704 E HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-7491
Practice Address - Country:US
Practice Address - Phone:573-783-2570
Practice Address - Fax:573-783-7045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506076207Medicaid