MEDICARE: MRS. ELIZABETH J HAWKINS-CHERNOF OTD

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	225X00000X	Occupational Therapist	2004000651	MO

General Provider Information

NPI Number	:	1447722160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH J HAWKINS-CHERNOF OTD

Provider Business Mailing Address
First Line	:	4444 FOREST PARK AVE
Second Line	:	CB 8505
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2212
Country	:	US
Telephone Number	:	314-286-1669
Fax Number	:	314-286-1601

Provider Business Practice Location Address
First Line	:	5232 OAKLAND AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1436
Country	:	US
Telephone Number	:	314-286-1669
Fax Number	:	314-289-6131

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

Provider Enumeration Date	:	12/19/2018
Last Update Date	:	03/28/2019

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