Healthcare Provider Details

I. General information

NPI: 1275935108
Provider Name (Legal Business Name): MRS. JENNIFER ANDREWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11960 WESTLINE INDUSTRIAL DR SUITE 201
SAINT LOUIS MO
63146-3209
US

IV. Provider business mailing address

1611 SPRINGMILL DR
WENTZVILLE MO
63385-3027
US

V. Phone/Fax

Practice location:
  • Phone: 866-433-9555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2014022443
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: