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General NPI Number Information
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NPI Number | 1487828034
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Entity Type | Individual
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Provider Name | COURTNEY A. VICKERY
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Gender | Female
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 10560 OLD OLIVE STREET RD SUITE 100
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City | CREVE COEUR
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State | MO
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Zip | 63141-5916
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Country | US
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Telephone | 314-567-4707
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Fax | 314-567-4505
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Provider Business Mailing Address
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Address Line | 1108 BONHOMME LAKE DR APT. H
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City | OLIVETTE
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State | MO
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Zip | 63132-5305
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Country | US
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Telephone | 573-576-6303
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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 | 2007035740
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License Number State | MO
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