Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 2002002536 | MO |
NPI | 1063798288 |
---|---|
Provider Name | Stacie L Luter |
First Address | Saint Louis, MO 63119-4414 |
Second Address | Saint Louis, MO 63119-4414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2011 |
Last Update Date | 04/11/2011 |