Healthcare Provider Details

I. General information

NPI: 1396739124
Provider Name (Legal Business Name): HOWARD PARK EARLY INTERVENTION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 05/23/2024
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 HEADQUARTERS PARK DR.
FENTON MO
63026-1910
US

IV. Provider business mailing address

1078 HEADQUARTERS PARK DR.
FENTON MO
63026-1910
US

V. Phone/Fax

Practice location:
  • Phone: 636-405-2701
  • Fax: 636-422-1223
Mailing address:
  • Phone: 636-405-2701
  • Fax: 636-422-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number369-8742
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SHEILA CHARLTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 636-405-2701