Healthcare Provider Details

I. General information

NPI: 1437886207
Provider Name (Legal Business Name): MELISSA R ULRICH COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA R SPILKER COTA/L

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 JUNGERMANN RD
SAINT PETERS MO
63376-5350
US

IV. Provider business mailing address

324 JUNGERMANN RD
SAINT PETERS MO
63376-5350
US

V. Phone/Fax

Practice location:
  • Phone: 636-928-5327
  • Fax: 636-928-5322
Mailing address:
  • Phone: 636-928-5327
  • Fax: 636-928-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2014027295
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: