Provider Demographics
NPI:1922405778
Name:SNODGRASS, KARA LYNNE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:LYNNE
Last Name:SNODGRASS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 212
Mailing Address - Street 2:
Mailing Address - City:QUEEN CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63561-9779
Mailing Address - Country:US
Mailing Address - Phone:660-766-2291
Mailing Address - Fax:660-766-2293
Practice Address - Street 1:1100 CLUB VILLAGE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4409
Practice Address - Country:US
Practice Address - Phone:573-256-2777
Practice Address - Fax:573-256-2764
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011002325224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant