Healthcare Provider Details

I. General information

NPI: 1649229329
Provider Name (Legal Business Name): PATRICIA LYNN NOONAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON BARRACKS DR MAIL CODE: 117
SAINT LOUIS MO
63125-4181
US

IV. Provider business mailing address

2838 LAKESIDE DR
COLUMBIA IL
62236-2681
US

V. Phone/Fax

Practice location:
  • Phone: 314-894-6629
  • Fax: 314-845-5077
Mailing address:
  • Phone: 618-281-4596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2000156782
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: