Provider Demographics
NPI:1063106474
Name:MAXIMUM FUNCTION OCCUPATIONAL THERAPY LLC
Entity type:Organization
Organization Name:MAXIMUM FUNCTION OCCUPATIONAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-425-4341
Mailing Address - Street 1:9568 LAWRENCE 2077
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-6272
Mailing Address - Country:US
Mailing Address - Phone:417-425-4341
Mailing Address - Fax:
Practice Address - Street 1:9568 LAWRENCE 2077
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-6272
Practice Address - Country:US
Practice Address - Phone:417-425-4341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty