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General NPI Number Information
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NPI Number | 1013666403
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Entity Type | Organization
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Legal Business Name | LIFETIME REDESIGN OT, PLLC
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 12395 OLIVE BLVD STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63141-5465
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Country | US
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Telephone | 646-319-9017
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Fax |
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Provider Business Mailing Address
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Address Line | 1449 S MICHIGAN AVE STE 13138
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City | CHICAGO
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State | IL
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Zip | 60605-2810
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Country | US
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Telephone | 646-319-9017
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JOSEPH MITCHELL
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Credential |
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Telephone | 270-993-4789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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