MEDICARE: THE WORK CENTER, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QX0100X	Occupational Medicine Clinic/Center
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1063603140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WORK CENTER, INC

Provider Business Mailing Address
First Line	:	111 WESTPORT PLZ
Second Line	:	SUITE 1100
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3011
Country	:	US
Telephone Number	:	314-434-2885
Fax Number	:	314-576-1006

Provider Business Practice Location Address
First Line	:	4004 PEACH CT
Second Line	:	SUITE H
City	:	COLUMBIA
State	:	MO
Zip	:	65203-3800
Country	:	US
Telephone Number	:	573-256-8100
Fax Number	:	573-256-8104

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MICHAEL FALLWELL
Credential	:	OTR/L
Telephone Number	:	314-434-2886

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	08/05/2007

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