Healthcare Provider Details

I. General information

NPI: 1003926130
Provider Name (Legal Business Name): ANN HEATH PIETROBURGO OTR CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 CHIPPEWA STE F
ST LOUIS MO
63116
US

IV. Provider business mailing address

615 NIRK AVE
KIRKWOOD MO
63122
US

V. Phone/Fax

Practice location:
  • Phone: 314-351-7172
  • Fax: 314-351-6885
Mailing address:
  • Phone: 314-965-2136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number004321
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: