Provider Demographics
NPI:1770028540
Name:WORSHAM, PATRICIA (MOT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WORSHAM
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 1/2 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2904
Mailing Address - Country:US
Mailing Address - Phone:816-261-4773
Mailing Address - Fax:
Practice Address - Street 1:205 1/2 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2904
Practice Address - Country:US
Practice Address - Phone:816-261-4773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084982225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist