Healthcare Provider Details

I. General information

NPI: 1073454096
Provider Name (Legal Business Name): LORA RACHAEL SCHMITTLING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON BARRACKS DR
SAINT LOUIS MO
63125-4181
US

IV. Provider business mailing address

5519 WILLOW CROSSING ST
SMITHTON IL
62285-3676
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax:
Mailing address:
  • Phone: 314-652-4100
  • Fax: 618-604-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number49553
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: