Provider Demographics
NPI:1356525687
Name:WAFULA, MARYANGELA NAFULA (MHS OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MARYANGELA
Middle Name:NAFULA
Last Name:WAFULA
Suffix:
Gender:F
Credentials:MHS OTR/L
Other - Prefix:MISS
Other - First Name:MARYANGELA
Other - Middle Name:NAFULA
Other - Last Name:KIBUYWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:901 COLGATE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1817
Mailing Address - Country:US
Mailing Address - Phone:573-446-4112
Mailing Address - Fax:
Practice Address - Street 1:1801 TOWNE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-2337
Practice Address - Country:US
Practice Address - Phone:573-474-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003499225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist