Healthcare Provider Details

I. General information

NPI: 1376459693
Provider Name (Legal Business Name): GRACE BARBAGALLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3585 VOGEL RD
ARNOLD MO
63010-3793
US

IV. Provider business mailing address

3311 WATSON RD
FESTUS MO
63028-3543
US

V. Phone/Fax

Practice location:
  • Phone: 636-282-1480
  • Fax:
Mailing address:
  • Phone: 636-524-5857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2022003497
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: