Healthcare Provider Details

I. General information

NPI: 1013382886
Provider Name (Legal Business Name): KATHERINE RUMMEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12335 W BEND DR
SAINT LOUIS MO
63128-2160
US

IV. Provider business mailing address

12335 W BEND DR
SAINT LOUIS MO
63128-2160
US

V. Phone/Fax

Practice location:
  • Phone: 877-931-1590
  • Fax:
Mailing address:
  • Phone: 877-931-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number2004019052
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number2004019052
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number2004019052
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: