1871648683 NPI number — MRS. RHONDA ELAINE IMHOFF O.T.

Table of content: MRS. RHONDA ELAINE IMHOFF O.T. (NPI 1871648683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871648683 NPI number — MRS. RHONDA ELAINE IMHOFF O.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IMHOFF
Provider First Name:
RHONDA
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
O.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KUESTER
Provider Other First Name:
RHONDA
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871648683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56781 LITTLE MONITEAU RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALIFORNIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65018-3066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-796-2331
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1115 FAIRGROUNDS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65109-5443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-634-3070
Provider Business Practice Location Address Fax Number:
573-636-3247
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  1455 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com