Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2018010382 | MO |
NPI | 1003306192 |
---|---|
Provider Name | Rachel Massicotte |
First Address | Creve Coeur, MO 63141-5922 |
Second Address | Creve Coeur, MO 63141-5922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2018 |
Last Update Date | 14/05/2018 |