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General NPI Number Information
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NPI Number | 1174123624
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Entity Type | Individual
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Provider Name | MRS. JORDAN ELISE STULCE
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Gender | Female
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 2025 HANLEY RD
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City | DARDENNE PRAIRIE
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State | MO
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Zip | 63368-6734
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Country | US
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Telephone | 636-561-5755
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Fax |
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Provider Business Mailing Address
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Address Line | 4304 HINEMAN DR
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City | SAINT CHARLES
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State | MO
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Zip | 63301-4520
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Country | US
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Telephone | 314-489-9991
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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 | 2020037749
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License Number State | MO
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