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General NPI Number Information
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NPI Number | 1548302672
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Entity Type | Individual
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Provider Name | MISS THERESA MARIE ALLARD
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 15089 MANOR CREEK DR
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City | CHESTERFIELD
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State | MO
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Zip | 63017-7717
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Country | US
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Telephone | 314-941-5765
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Fax |
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Provider Business Mailing Address
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Address Line | 11923 HOLLY BROOK DR
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-1347
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Country | US
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Telephone | 314-770-9054
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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 | 005014
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License Number State | MO
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