Healthcare Provider Details

I. General information

NPI: 1518656024
Provider Name (Legal Business Name): NATALIE THEURER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

2122 TROY ROAD SUITE 120
EDWARDSVILLE IL
62025-2540
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-5437
  • Fax:
Mailing address:
  • Phone: 618-800-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: