Healthcare Provider Details

I. General information

NPI: 1639189160
Provider Name (Legal Business Name): MISTY LYNN CULP MHA,OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 SPENCER RD SUITE D
SAINT PETERS MO
63376-2438
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 636-477-9911
  • Fax: 636-477-9929
Mailing address:
  • Phone: 630-575-6250
  • Fax: 630-575-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number001298
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: