Healthcare Provider Details

I. General information

NPI: 1235410754
Provider Name (Legal Business Name): BRITTANY NICOLE MUSICK OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 N. WARSON RD.
ST. LOUIS MO
63132
US

IV. Provider business mailing address

1177 N. WARSON RD
ST. LOUIS MO
63132
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-2211
  • Fax: 314-569-3656
Mailing address:
  • Phone: 314-569-2211
  • Fax: 314-569-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2011027050
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: