Healthcare Provider Details

I. General information

NPI: 1124956347
Provider Name (Legal Business Name): CHIYAH SHANEL COWPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 BELLEVUE AVE
SAINT LOUIS MO
63117-1996
US

IV. Provider business mailing address

1027 BELLEVUE AVE
SAINT LOUIS MO
63117-1996
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-5202
  • Fax: 314-951-5908
Mailing address:
  • Phone: 314-768-5202
  • Fax: 314-951-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: