Healthcare Provider Details

I. General information

NPI: 1063335446
Provider Name (Legal Business Name): EMILY WIECHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
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

1121 WILD PLUM DR
SAINT PETERS MO
63303-1209
US

V. Phone/Fax

Practice location:
  • Phone: 636-922-4700
  • Fax: 636-922-4505
Mailing address:
  • Phone: 618-541-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2024006955
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: