Healthcare Provider Details

I. General information

NPI: 1316275324
Provider Name (Legal Business Name): MISS ALLISON DIANE TOENJES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 DOLMAN ST
SAINT LOUIS MO
63104-3307
US

IV. Provider business mailing address

118 WESTHAVEN SCHOOL RD
BELLEVILLE IL
62220-3264
US

V. Phone/Fax

Practice location:
  • Phone: 314-494-6337
  • Fax:
Mailing address:
  • Phone: 618-257-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057.002078
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: