Healthcare Provider Details

I. General information

NPI: 1508694951
Provider Name (Legal Business Name): GRACE MOHR MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 S GRAND BLVD STE 224
SAINT LOUIS MO
63118-1047
US

IV. Provider business mailing address

1626 WISHWOOD CT APT 4
CHESTERFIELD MO
63017-8504
US

V. Phone/Fax

Practice location:
  • Phone: 314-312-2357
  • Fax:
Mailing address:
  • Phone: 812-573-8528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2024034537
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: