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General NPI Number Information
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NPI Number | 1073889739
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Entity Type | Individual
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Provider Name | AJA BETHANY OTR
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Gender | Female
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 10600 LEWIS AND CLARK BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63136-6005
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Country | US
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Telephone | 314-283-6955
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Fax |
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Provider Business Mailing Address
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Address Line | 5368 SUNTRAIL DR
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City | BLACK JACK
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State | MO
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Zip | 63033-4425
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Country | US
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Telephone | 314-283-6955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2006003768
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License Number State | MO
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