Healthcare Provider Details

I. General information

NPI: 1366517633
Provider Name (Legal Business Name): BRANDEE JUDY ZAHNER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 MAGNOLIA AVE
SAINT LOUIS MO
63110-4025
US

IV. Provider business mailing address

3333 ILLINOIS AVE
SAINT LOUIS MO
63118-3240
US

V. Phone/Fax

Practice location:
  • Phone: 314-776-4320
  • Fax: 314-776-1875
Mailing address:
  • Phone: 314-776-4320
  • Fax: 314-776-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2000169662
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: