Provider Demographics
NPI:1841790631
Name:JOSEPH, PATRICIA ANN (OTR)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 AZTEC BLVD APT 60
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-2940
Mailing Address - Country:US
Mailing Address - Phone:215-266-3571
Mailing Address - Fax:
Practice Address - Street 1:200 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:MO
Practice Address - Zip Code:65275-1165
Practice Address - Country:US
Practice Address - Phone:660-327-4125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-18
Last Update Date:2018-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018003409225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist