Healthcare Provider Details

I. General information

NPI: 1912604281
Provider Name (Legal Business Name): FUNCTION FIRST THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6613 LACONIA DR
SAINT LOUIS MO
63123-2621
US

IV. Provider business mailing address

6613 LACONIA DR
SAINT LOUIS MO
63123-2621
US

V. Phone/Fax

Practice location:
  • Phone: 573-579-4461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JORDAN POORE
Title or Position: OCCUPATIONAL THERAPIST
Credential: MOT, OTR/L
Phone: 573-579-4461