Healthcare Provider Details

I. General information

NPI: 1063331346
Provider Name (Legal Business Name): MOLLY MEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 N CLOVERLEAF DR STE J
SAINT PETERS MO
63376-6436
US

IV. Provider business mailing address

511 S BENTON AVE
SAINT CHARLES MO
63301-2643
US

V. Phone/Fax

Practice location:
  • Phone: 636-922-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2025009958
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: