Provider Demographics
NPI:1578681607
Name:BOLIVAR R0I
Entity type:Organization
Organization Name:BOLIVAR R0I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DAUGHTREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-326-3811
Mailing Address - Street 1:604 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-1904
Mailing Address - Country:US
Mailing Address - Phone:417-326-3811
Mailing Address - Fax:
Practice Address - Street 1:604 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-1904
Practice Address - Country:US
Practice Address - Phone:417-326-3811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)