Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 2000157770 | MO |
NPI | 1003450834 |
---|---|
Provider Name | Ms. Luu Thi Wong |
First Address | Saint Louis, MO 63108-2212 |
Second Address | Chesterfield, MO 63017-5705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2019 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
470085679 | (05) | MO |