MEDICARE: WESLY SAINTLOUIS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	225100000X	Physical Therapist
3	225X00000X	Occupational Therapist
4	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1184261521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WESLY SAINTLOUIS

Provider Business Mailing Address
First Line	:	1159 SEPIA LN
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-3325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1159 SEPIA LN
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-3325
Country	:	US
Telephone Number	:	772-200-1037
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2019
Last Update Date	:	12/27/2019

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Directions to “ WESLY SAINTLOUIS ” Practice Location

Language	Start Address	Practice Location

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