Healthcare Provider Details

I. General information

NPI: 1780246413
Provider Name (Legal Business Name): ALLISON HARRES MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/02/2019
Certification Date:
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2018029637
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: