Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 004698 | MO |
NPI | 1003958778 |
---|---|
Provider Name | Mrs. Jennifer Beth Pelikan |
First Address | Florissant, MO 63031-1227 |
Second Address | Hazelwood, MO 63042-1143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |