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General NPI Number Information
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NPI Number | 1740305333
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Entity Type | Individual
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Provider Name | THERESA MICHELLE HUBERT OTR
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 250 NEW FLORISSANT RD SOUTH
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City | FLORISSANT
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State | MO
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Zip | 63031
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Country | US
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Telephone | 314-830-7950
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Fax |
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Provider Business Mailing Address
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Address Line | 1127 OLIVE LAKE DR APT. D
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City | ST. LOUIS
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State | MO
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Zip | 63132
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Country | US
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Telephone | 314-471-9780
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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 | 2006001181
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License Number State | MO
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