Provider Demographics
NPI:1588430664
Name:PLUMBERG, NATASHA (COTA/L)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:PLUMBERG
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:312 E ROSALIE
Mailing Address - Street 2:
Mailing Address - City:STRAFFORD
Mailing Address - State:MO
Mailing Address - Zip Code:65757-4222
Mailing Address - Country:US
Mailing Address - Phone:417-463-0881
Mailing Address - Fax:
Practice Address - Street 1:1501 E PYTHIAN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2139
Practice Address - Country:US
Practice Address - Phone:417-864-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021040187224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant