Healthcare Provider Details

I. General information

NPI: 1861369894
Provider Name (Legal Business Name): LEIA MINA WACHSSTOCK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEIA RUBIN OTR/L

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MILLSTONE CAMPUS DR STE 1000
SAINT LOUIS MO
63146-5761
US

IV. Provider business mailing address

869 BERICK DR
SAINT LOUIS MO
63132-4808
US

V. Phone/Fax

Practice location:
  • Phone: 314-648-8266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: