Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2004019225 | MO |
N | 225XE0001X | Environmental Modification | 2004019225 | MO |
N | 225XG0600X | Occupational Therapist - Gerontology | 2004019225 | MO |
NPI | 1720399462 |
---|---|
Provider Name | Ms. Susan Shayne Goldstein |
First Address | Saint Louis, MO 63146-4909 |
Second Address | Saint Louis, MO 63146-4909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2010 |
Last Update Date | 28/06/2010 |