MEDICARE: GIFTED TOUCH LLC

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1154853828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIFTED TOUCH LLC

Provider Business Mailing Address
First Line	:	1736 KEELEN DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-2441
Country	:	US
Telephone Number	:	314-598-1058
Fax Number	:

Provider Business Practice Location Address
First Line	:	1736 KEELEN DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-2441
Country	:	US
Telephone Number	:	314-598-1058
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FREDERICK GLEN HENDERSON JR.
Credential	:
Telephone Number	:	314-598-1058

Provider Enumeration Date	:	03/31/2017
Last Update Date	:	03/31/2017

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