Healthcare Provider Details

I. General information

NPI: 1386823714
Provider Name (Legal Business Name): PEGGY P BARCO OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 04/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 FOREST PARK AVE DEPT OCCUPATIONAL THERAPY, STE 2210
SAINT LOUIS MO
63108-2212
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-1669
  • Fax: 314-289-6131
Mailing address:
  • Phone: 314-286-1669
  • Fax: 314-289-6131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number004941
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: