Healthcare Provider Details

I. General information

NPI: 1730968744
Provider Name (Legal Business Name): ALICIA BRUEGGEMANN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 05/18/2026
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 A ROY DR DEPT OCCUPATIONAL THERAPY
WASHINGTON MO
63090-5008
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-1669
  • Fax: 314-627-7219
Mailing address:
  • Phone: 314-286-1669
  • Fax: 314-627-7219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2022043571
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: