Healthcare Provider Details

I. General information

NPI: 1235051475
Provider Name (Legal Business Name): ADDISON JARUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 S CRESCENT DR
KIRKWOOD MO
63122-4629
US

IV. Provider business mailing address

524 S CRESCENT DR
KIRKWOOD MO
63122-4629
US

V. Phone/Fax

Practice location:
  • Phone: 314-447-8511
  • Fax: 314-447-8747
Mailing address:
  • Phone: 314-447-8511
  • Fax: 314-447-8747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2026012716
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: