Healthcare Provider Details

I. General information

NPI: 1598249369
Provider Name (Legal Business Name): EMILY THIEMAN MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 08/21/2023
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DISCOVERY PATH LN
SAINT CHARLES MO
63301-0114
US

IV. Provider business mailing address

1601 MCQUADE DR
SAINT PETERS MO
63376-7804
US

V. Phone/Fax

Practice location:
  • Phone: 314-799-9939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2022007934
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: