Healthcare Provider Details

I. General information

NPI: 1821139635
Provider Name (Legal Business Name): YVETTE JACINTA THOMAS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 STONEY TERRACE DR
BALLWIN MO
63021-7783
US

IV. Provider business mailing address

1703 STONEY TERRACE DR
BALLWIN MO
63021-7783
US

V. Phone/Fax

Practice location:
  • Phone: 314-239-0313
  • Fax: 636-226-4712
Mailing address:
  • Phone: 314-239-0313
  • Fax: 636-226-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number001382
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: