MEDICARE: LIFE SKILLS THERAPY SERVICES, LLC

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	2001001156	MO

General Provider Information

NPI Number	:	1023313814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE SKILLS THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	7869 WAYNE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-1231
Country	:	US
Telephone Number	:	314-477-9523
Fax Number	:	314-863-7662

Provider Business Practice Location Address
First Line	:	7869 WAYNE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-1231
Country	:	US
Telephone Number	:	314-477-9523
Fax Number	:	314-863-7662

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. SELENA CARTER
Credential	:	MS, OTR/L
Telephone Number	:	314-477-9523

Provider Enumeration Date	:	01/25/2011
Last Update Date	:	02/01/2011

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