Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 000578 | MO |
NPI | 1679061808 |
---|---|
Provider Name | Ms. Susan Swyers Grogan |
First Address | St. Louis, MO 63129 |
Second Address | St. Louis, MO 63129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2018 |
Last Update Date | 24/04/2018 |