Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | MO |
NPI | 1023775871 |
---|---|
Provider Name | Mrs. Jenifer Ann Ecker |
First Address | Saint Louis, MO 63129-4238 |
Second Address | Saint Louis, MO 63129-4238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2021 |
Last Update Date | 29/11/2021 |