Healthcare Provider Details

I. General information

NPI: 1912269705
Provider Name (Legal Business Name): 3 PEDS IN A POD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 TRIAD CENTER DR
SAINT PETERS MO
63376-7350
US

IV. Provider business mailing address

1370 TRIAD CENTER DR
SAINT PETERS MO
63376-7350
US

V. Phone/Fax

Practice location:
  • Phone: 636-466-2524
  • Fax:
Mailing address:
  • Phone: 636-466-2524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1300X
TaxonomyHuman Factors Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MISS CARRIE LYNN JOST
Title or Position: MANAGER
Credential: OTR/L
Phone: 636-466-2524