Healthcare Provider Details

I. General information

NPI: 1952149296
Provider Name (Legal Business Name): ALLYSON ZANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON BARRACKS DR
SAINT LOUIS MO
63125-4181
US

IV. Provider business mailing address

85 ROCKLEDGE CT
SAINT CHARLES MO
63303-7302
US

V. Phone/Fax

Practice location:
  • Phone: 314-200-3684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number83352
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: