MEDICARE: MRS. DORIAN LEE MENZEL OTR

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	005314	MO

General Provider Information

NPI Number	:	1114073673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DORIAN LEE MENZEL OTR

Provider Business Mailing Address
First Line	:	7 HARBOR POINT CT
Second Line	:
City	:	LAKE ST LOUIS
State	:	MO
Zip	:	63367-1336
Country	:	US
Telephone Number	:	636-561-1068
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 HARBOR POINT CT
Second Line	:
City	:	LAKE ST LOUIS
State	:	MO
Zip	:	63367-1336
Country	:	US
Telephone Number	:	636-561-1068
Fax Number	:

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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