Healthcare Provider Details

I. General information

NPI: 1053225318
Provider Name (Legal Business Name): ERIN BACKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 FOREST PARK AVE STE 302
SAINT LOUIS MO
63108-2979
US

IV. Provider business mailing address

4718 TAMM AVE
SAINT LOUIS MO
63109-2710
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-1669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2014009143
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: