Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2017044641 | MO |
N | 225XF0002X | Feeding, Eating & Swallowing | 2017044641 | MO |
N | 225XP0200X | Occupational Therapist - Pediatrics | 2017044641 | MO |
NPI | 1609371400 |
---|---|
Provider Name | Rebecca Fisher |
First Address | Saint Louis, MO 63139-3731 |
Second Address | Saint Louis, MO 63139-3731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2018 |
Last Update Date | 11/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
470052186 | (05) | MO |