Healthcare Provider Details

I. General information

NPI: 1518894724
Provider Name (Legal Business Name): LAUREL HUBSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 LAKE BEND DR
VALLEY PARK MO
63088-2524
US

IV. Provider business mailing address

16350 LYDIA HILL DR APT 3221
CHESTERFIELD MO
63017-7900
US

V. Phone/Fax

Practice location:
  • Phone: 636-289-0465
  • Fax:
Mailing address:
  • Phone: 812-351-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2026010419
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: