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General NPI Number Information
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NPI Number | 1326309873
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Entity Type | Individual
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Provider Name | ANTHONY DEWAYNE TOWNSEND COTA/L
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Gender | Male
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Dates
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Enumeration Date | 05/31/2012
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 1265 MCLARAN AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63147-1606
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Country | US
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Telephone | 314-388-4121
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Fax | 314-395-3103
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Provider Business Mailing Address
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Address Line | 4153 WASHINGTON BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63108-3134
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Country | US
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Telephone | 314-315-2264
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Fax | 314-652-9500
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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 | 2010015742
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057.003235
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License Number State | IL
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