Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2003014079 | MO |
NPI | 1073664561 |
---|---|
Provider Name | Jennifer D Allen |
First Address | Saint Louis, MO 63109-3117 |
Second Address | Saint Louis, MO 63125-4424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2007 |
Last Update Date | 08/07/2007 |