Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2007004534 | MO |
NPI | 1063690550 |
---|---|
Provider Name | Michele Marie Zimmerman |
First Address | St. Louis, MO 63122-4625 |
Second Address | St. Louis, MO 63122-4625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2008 |
Last Update Date | 06/02/2008 |