Healthcare Provider Details

I. General information

NPI: 1790606291
Provider Name (Legal Business Name): ASHLEY MCCULLOCH OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

625 N EUCLID AVE APT 610
SAINT LOUIS MO
63108-1713
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2026034893
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: