MEDICARE: BRICKS AND BITES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	225XP0200X	Pediatrics
3	235Z00000X	Speech-Language Pathologist
4	225XF0002X	Feeding, Eating & Swallowing

General Provider Information

NPI Number	:	1023626983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRICKS AND BITES LLC

Provider Business Mailing Address
First Line	:	6929 WISE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3731
Country	:	US
Telephone Number	:	314-297-8008
Fax Number	:	314-530-0315

Provider Business Practice Location Address
First Line	:	6929 WISE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3731
Country	:	US
Telephone Number	:	314-312-2984
Fax Number	:	314-530-0315

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	REBECCA FISHER
Credential	:	OTR/L
Telephone Number	:	314-314-2984

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	07/16/2020

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Directions to “BRICKS AND BITES LLC ” Practice Location

Language	Start Address	Practice Location

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