Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2008026352 | MO |
NPI | 1003049958 |
---|---|
Provider Name | Ashley L Crecelius |
First Address | Saint Louis, MO 63123-5065 |
Second Address | Creve Coeur, MO 63141-5916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2009 |
Last Update Date | 15/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114090792 | (05) | MO |