Healthcare Provider Details

I. General information

NPI: 1275593519
Provider Name (Legal Business Name): CONNIE RHOADS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13537 BARRETT PARKWAY DR STE 200
MANCHESTER MO
63021-5899
US

IV. Provider business mailing address

1720 STONEY TERRACE DR
BALLWIN MO
63021-7782
US

V. Phone/Fax

Practice location:
  • Phone: 314-966-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: