MEDICARE: ZOE CHRACHELLA ROSS OTR/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
1	225X00000X	Occupational Therapist	2021021708	MO

General Provider Information

NPI Number	:	1972172393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZOE CHRACHELLA ROSS OTR/L

Provider Business Mailing Address
First Line	:	530 UNION BLVD APT 808
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1146
Country	:	US
Telephone Number	:	217-313-7753
Fax Number	:

Provider Business Practice Location Address
First Line	:	2963 DODDRIGE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63043
Country	:	US
Telephone Number	:	314-409-8240
Fax Number	:

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

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	06/21/2021

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