MEDICARE: MR. JAMES ROBERT DAUBER OTR/L, ATP

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	003825	MO

General Provider Information

NPI Number	:	1487234126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES ROBERT DAUBER OTR/L, ATP

Provider Business Mailing Address
First Line	:	7730 CARONDELET AVE STE 400
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3329
Country	:	US
Telephone Number	:	314-202-5516
Fax Number	:	618-202-1069

Provider Business Practice Location Address
First Line	:	1146 E LAKEWOOD ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810-2614
Country	:	US
Telephone Number	:	417-216-7254
Fax Number	:	417-885-9050

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

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	04/08/2021

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