Provider Demographics
NPI:1942512488
Name:CAUDILL-JAMES, PHYLLIS FAY (COTA/L)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:FAY
Last Name:CAUDILL-JAMES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 W SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-1850
Mailing Address - Country:US
Mailing Address - Phone:417-678-6101
Mailing Address - Fax:
Practice Address - Street 1:915 CARL ALLEN ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-1612
Practice Address - Country:US
Practice Address - Phone:417-461-7018
Practice Address - Fax:417-461-7026
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006020322224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant