Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2013035764 | MO |
NPI | 1063849958 |
---|---|
Provider Name | Anna J Fahs |
First Address | St. Louis, MO 63132 |
Second Address | St. Louis, MO 63132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2013 |
Last Update Date | 30/01/2014 |