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General NPI Number Information
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NPI Number | 1144039264
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Entity Type | Individual
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Provider Name | ANNA MIKHAILOVA
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Gender | Female
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 1130 N EUCLID AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63113-2010
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Country | US
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Telephone | 314-361-0432
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Fax |
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Provider Business Mailing Address
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Address Line | 12131 BECKFORD ESTATES DR
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-4220
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Country | US
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Telephone | 719-360-3962
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 511519
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License Number State | MO
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