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NPI Code Detail

MEDICARE: LAURA SIDDLE MOT/R, CLC

MEDICARE: LAURA SIDDLE MOT/R, CLC
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
1225X00000XOccupational Therapist2014024526MO

General Provider Information

NPI Number : 1063162014
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA SIDDLE MOT/R, CLC
Provider Business Mailing Address
First Line : 3029 COUNTRY KNOLL DR
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-6368
Country : US
Telephone Number : 636-359-5540
Fax Number :
Provider Business Practice Location Address
First Line : 2150 W RANDOLPH ST
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63301-0844
Country : US
Telephone Number : 636-946-4966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2022
Last Update Date : 03/24/2022

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