Provider Demographics
NPI:1881975449
Name:BASKARAN, PERSIS RUPAMATHY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:PERSIS
Middle Name:RUPAMATHY
Last Name:BASKARAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 WINDERMERE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6424
Mailing Address - Country:US
Mailing Address - Phone:573-673-3321
Mailing Address - Fax:
Practice Address - Street 1:1201 HUNT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-1367
Practice Address - Country:US
Practice Address - Phone:573-449-1448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004071225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist