MEDICARE: MRS. SUSAN KAY GRISPINO OTR L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	000840	MO

General Provider Information

NPI Number	:	1023235975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN KAY GRISPINO OTR L

Provider Business Mailing Address
First Line	:	24694 HAWK RD
Second Line	:
City	:	MARYVILLE
State	:	MO
Zip	:	64468-8185
Country	:	US
Telephone Number	:	660-582-8105
Fax Number	:

Provider Business Practice Location Address
First Line	:	AREA COOPERATIVE FOR EDUCATIONAL SUPPORT
Second Line	:	1429 SOUTH MUNN AVENUE
City	:	MARYVILLE
State	:	MO
Zip	:	64468
Country	:	US
Telephone Number	:	660-582-3768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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