MEDICARE: MS. JEANETTE M SEITRICH MOTR/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	2016036932	MO
2	225XP0200X	Pediatric Occupational Therapist	2016036932	MO

General Provider Information

NPI Number	:	1023533312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANETTE M SEITRICH MOTR/L

Provider Business Mailing Address
First Line	:	12110 CLAYTON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2516
Country	:	US
Telephone Number	:	314-989-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	9801 EDGEFIELD DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-5418
Country	:	US
Telephone Number	:	314-868-2454
Fax Number	:

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

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	04/26/2019

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