Healthcare Provider Details

I. General information

NPI: 1730305731
Provider Name (Legal Business Name): CINDY CRABTREE DEMENDOZA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY LEE CRABTREE OTR/L

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N 11TH ST MEDICAID DEPARTMENT
SAINT LOUIS MO
63101-1015
US

IV. Provider business mailing address

561 N LACLEDE STATION RD
WEBSTER GROVES MO
63119-2048
US

V. Phone/Fax

Practice location:
  • Phone: 314-345-2535
  • Fax: 314-345-2653
Mailing address:
  • Phone: 314-475-5115
  • Fax: 314-475-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number996185
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: