=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396319893
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA FLATLEY MOT, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2021
-----------------------------------------------------
Last Update Date | 05/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 MEADOWLANDS ESTATES LN
-----------------------------------------------------
City | O FALLON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63366-4712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-614-1441
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 708 BROOK MANOR CT
-----------------------------------------------------
City | LAKE SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63367-4513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-328-7852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 2014034797
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------