Healthcare Provider Details

I. General information

NPI: 1407673742
Provider Name (Legal Business Name): PATRICIA HENNESSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATSY HENNESSEY

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/26/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S KIRKWOOD RD STE 150
KIRKWOOD MO
63122-7251
US

IV. Provider business mailing address

625 N CLAY AVE
SAINT LOUIS MO
63122-2705
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-7554
  • Fax:
Mailing address:
  • Phone: 314-564-2783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2024039120
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: