Healthcare Provider Details

I. General information

NPI: 1659500619
Provider Name (Legal Business Name): HEATHER A JONES OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1082 OLD DES PERES RD
SAINT LOUIS MO
63131-1865
US

IV. Provider business mailing address

1082 OLD DES PERES RD
SAINT LOUIS MO
63131-1865
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-5230
  • Fax:
Mailing address:
  • Phone: 314-821-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2009017773
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: