Provider Demographics
NPI:1912177213
Name:OZBENT, JOAN LAMANILAO
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:LAMANILAO
Last Name:OZBENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:GALOLO
Other - Last Name:LAMANILAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:206 MADISON ST
Mailing Address - Street 2:APT. E
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-1735
Mailing Address - Country:US
Mailing Address - Phone:870-897-4603
Mailing Address - Fax:
Practice Address - Street 1:500 BARRETT DR
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MO
Practice Address - Zip Code:63863-1204
Practice Address - Country:US
Practice Address - Phone:573-276-3843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006001773225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist