Provider Demographics
NPI:1538936877
Name:WELLS, VERONICA HAILEY
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:HAILEY
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5195 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-6406
Mailing Address - Country:US
Mailing Address - Phone:417-684-7415
Mailing Address - Fax:
Practice Address - Street 1:5195 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-6406
Practice Address - Country:US
Practice Address - Phone:417-684-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2020005686224Z00000X
MO2020005686224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant