Healthcare Provider Details

I. General information

NPI: 1073664561
Provider Name (Legal Business Name): JENNIFER D ALLEN OTR.L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 LEMAY FERRY RD
SAINT LOUIS MO
63125-4424
US

IV. Provider business mailing address

5877 ITASKA ST
SAINT LOUIS MO
63109-3117
US

V. Phone/Fax

Practice location:
  • Phone: 314-845-7751
  • Fax:
Mailing address:
  • Phone: 314-353-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2003014079
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: