Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 112862 | TX |
N | 225XP0200X | Occupational Therapist - Pediatrics | 112862 | TX |
NPI | 1003069998 |
---|---|
Provider Name | Michelle Lauren Chambers |
First Address | Saint Louis, MO 63123-7040 |
Second Address | Saint Louis, MO 63123-7040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2008 |
Last Update Date | 17/03/2018 |