MEDICARE: MARGARET NICOLE DONNELLY

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	225XP0200X	Pediatric Occupational Therapist
2	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2022005471	OTHER	MO	OT LICENSE

General Provider Information

NPI Number	:	1043959901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET NICOLE DONNELLY

Provider Business Mailing Address
First Line	:	2404 MOUNTAIN PEAK CT
Second Line	:
City	:	PACIFIC
State	:	MO
Zip	:	63069-6609
Country	:	US
Telephone Number	:	636-575-9633
Fax Number	:

Provider Business Practice Location Address
First Line	:	3407 S JEFFERSON AVE STE 145
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-3119
Country	:	US
Telephone Number	:	314-833-8848
Fax Number	:

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

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	05/31/2022

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Directions to “ MARGARET NICOLE DONNELLY ” Practice Location

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