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NPI Code Detail

MEDICARE: MRS. KATHLEEN LOUISE WIEGMAN COTA/L

MEDICARE: MRS. KATHLEEN LOUISE WIEGMAN COTA/L
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
1174400000XSpecialist2007016351MO
2314000000XSkilled Nursing Facility2007016351MO

General Provider Information

NPI Number : 1568629137
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHLEEN LOUISE WIEGMAN COTA/L
Provider Business Mailing Address
First Line : 39 PILOT HILL DR
Second Line :
City : SAINT PETERS
State : MO
Zip : 63376-2739
Country : US
Telephone Number : 636-922-2656
Fax Number :
Provider Business Practice Location Address
First Line : 6768 N US HIGHWAY 67
Second Line :
City : FLORISSANT
State : MO
Zip : 63034-2742
Country : US
Telephone Number : 314-413-3657
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2008
Last Update Date : 05/20/2008

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