Healthcare Provider Details

I. General information

NPI: 1225783723
Provider Name (Legal Business Name): REBECCA BONDURANT OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5614 HAMPTON AVE
SAINT LOUIS MO
63109-3434
US

IV. Provider business mailing address

12533 GLENLEA DR
MARYLAND HEIGHTS MO
63043-2839
US

V. Phone/Fax

Practice location:
  • Phone: 314-271-0297
  • Fax: 314-641-6184
Mailing address:
  • Phone: 314-271-0297
  • Fax: 314-641-6184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2022012894
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2022012894
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: