Healthcare Provider Details

I. General information

NPI: 1457910747
Provider Name (Legal Business Name): BRITTNEY DANIELLE BYRTH MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 PARK AVE FL 2
SAINT LOUIS MO
63110-2514
US

IV. Provider business mailing address

5928 SCANLAN AVE APT 4
SAINT LOUIS MO
63139-2349
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5609
  • Fax:
Mailing address:
  • Phone: 314-906-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2019001237
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: