Healthcare Provider Details

I. General information

NPI: 1194913202
Provider Name (Legal Business Name): JAYNE R ABRAHAM OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAYNE R ABRAHAM OT

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 FENTON PLZ
FENTON MO
63026-4110
US

IV. Provider business mailing address

647 SPIRIT AIRPARK WEST DR STE 101
CHESTERFIELD MO
63005-1032
US

V. Phone/Fax

Practice location:
  • Phone: 636-493-8646
  • Fax:
Mailing address:
  • Phone: 636-223-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number00713
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2026020053
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: