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Mary Diane Johnson Tmd Outlet
Orthotic Fitter in Lebanon, Missouri
NPI 1649389388

Mary Diane Johnson Tmd Outlet is a Orthotic Fitter based in Lebanon, MO. Mary Diane Johnson Tmd Outlet practices in Lebanon, MO. The NPI Number for Mary Diane Johnson Tmd Outlet is 1649389388 and holds a License No. (Missouri).

The current practice location address for Mary Diane Johnson Tmd Outlet is 702 S Monroe, Lebanon, MO and can be reached out via phone at 417-588-3404 and via fax at 417-588-3404.

Location: 702 S Monroe, Lebanon, MO, 65536-3570
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1649389388
Provider Name
Mary Diane Johnson Tmd Outlet
Credential
Provider Entity Type
Organization
Address
702 S Monroe, Lebanon, MO, 65536-3570
Phone Number
417-588-3404
Fax Number
417-588-3404
Provider Enumeration Date
08/29/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
174584 01 MO BLUE CROSS/BLUE SHIELD
institution
Provider Business Practice Location Address Details
Address
702 S Monroe
City
Lebanon
State
Missouri
Zip
65536-3570
Phone Number
417-588-3404
Fax Number
417-588-3404
person
Provider Business Mailing Address Details
Address
702 S Monroe
City
Lebanon
State
Missouri
Zip
65536-3570
Phone Number
417-588-3404
Fax Number
417-588-3404
person
Provider's Taxonomy Details 1
Type
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Classification
Orthotic Fitter
Speciality
-
Taxonomy
225000000X
License No.
()
Definition
An individual trained in the management of fitting prefabricated orthoses.
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