Healthcare Provider Details

I. General information

NPI: 1326586207
Provider Name (Legal Business Name): LACI REUTHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MCKNIGHT PL
SAINT LOUIS MO
63124-2229
US

IV. Provider business mailing address

406 WINTER BLUFF DR
FENTON MO
63026-6578
US

V. Phone/Fax

Practice location:
  • Phone: 573-701-5640
  • Fax:
Mailing address:
  • Phone: 573-701-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2012039350
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: