Healthcare Provider Details

I. General information

NPI: 1497698336
Provider Name (Legal Business Name): SAVANNAH M MISSEY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 W HIGHWAY 50
O FALLON IL
62269-1828
US

IV. Provider business mailing address

436 W CENTRAL ST
BETHALTO IL
62010-1451
US

V. Phone/Fax

Practice location:
  • Phone: 618-726-0370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: