Healthcare Provider Details

I. General information

NPI: 1154536670
Provider Name (Legal Business Name): CATHERINE GENETTI OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8819 LAWN AVE
SAINT LOUIS MO
63144-1705
US

IV. Provider business mailing address

8819 LAWN AVE
SAINT LOUIS MO
63144-1705
US

V. Phone/Fax

Practice location:
  • Phone: 314-961-6151
  • Fax:
Mailing address:
  • Phone: 314-961-6151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: