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NPI Code Detail

MEDICARE: MRS. MAJA GRUDEN OT

MEDICARE:  MRS. MAJA  GRUDEN  OT
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
1171W00000XContractor2005010122MO

General Provider Information

NPI Number : 1548316532
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MAJA GRUDEN OT
Provider Business Mailing Address
First Line : 2561 ABBYDALE DRIVE
Second Line :
City : ST. CHARLES
State : MO
Zip : 63303
Country : US
Telephone Number : 636-928-3760
Fax Number : 636-928-2862
Provider Business Practice Location Address
First Line : 2561 ABBYDALE DR
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-3018
Country : US
Telephone Number : 636-928-3760
Fax Number : 636-928-2862
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. MAJA GRUDEN OT” Practice Location

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