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Contact Information

JACQUELYN SAMPLE, MED OTRL
300 PORTLAND STREET
COLUMBIA, MO65202
 Phone: 573-882-3757
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Occupational Therapist

225X00000X 67 Occupational Therapist in Private Practice
Indicates primary specialty

NPI Profile & details for JACQUELYN SAMPLE · (Female)

NPI Number 1568509867
Status Active
Credentials MED OTRL
Entity Individual
Enumeration date 01/30/2007
Last updated 08/07/2009 - About 17 years ago
Sole proprietor 1 No
Identifiers
  • MO License # 004712
  • MS Medicaid 476068812
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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