Healthcare Provider Details

I. General information

NPI: 1215069547
Provider Name (Legal Business Name): CAROL L HOHENSTREET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 NORTH SERVICE RD R-II
WRIGHT CITY MO
63390-0198
US

IV. Provider business mailing address

PO BOX 198 402 NORTH SERVICE ROAD
WRIGHT CITY MO
63390-0198
US

V. Phone/Fax

Practice location:
  • Phone: 636-745-7200
  • Fax: 636-745-3613
Mailing address:
  • Phone: 636-745-7200
  • Fax: 636-745-3613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number000375
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: