Healthcare Provider Details

I. General information

NPI: 1609371400
Provider Name (Legal Business Name): REBECCA FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6929 WISE AVE
SAINT LOUIS MO
63139-3731
US

IV. Provider business mailing address

6929 WISE AVE
SAINT LOUIS MO
63139-3731
US

V. Phone/Fax

Practice location:
  • Phone: 314-297-8008
  • Fax: 314-530-0315
Mailing address:
  • Phone: 314-297-8008
  • Fax: 314-530-0315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number2017044641
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2017044641
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2017044641
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: