Healthcare Provider Details

I. General information

NPI: 1154674901
Provider Name (Legal Business Name): ST. LOUIS CHILDRENS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SCHULTZ RD
SAINT LOUIS MO
63122-6550
US

IV. Provider business mailing address

12 SCHULTZ RD
SAINT LOUIS MO
63122-6550
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-9431
  • Fax:
Mailing address:
  • Phone: 314-821-9431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number
License Number StateMO

VIII. Authorized Official

Name: MRS. HEATHER VINCENT
Title or Position: OTR/L
Credential:
Phone: 314-215-6932