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NPI Code Detail

MEDICARE: VIJAYA KRISHNAMOORTHY OTR

MEDICARE: VIJAYA KRISHNAMOORTHY 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
1225X00000XOccupational Therapist056005466IL

General Provider Information

NPI Number : 1124260286
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIJAYA KRISHNAMOORTHY OTR
Provider Business Mailing Address
First Line : 2800 CRESTFIELD CT
Second Line :
City : NAPERVILLE
State : IL
Zip : 60565-3043
Country : US
Telephone Number : 630-416-7939
Fax Number :
Provider Business Practice Location Address
First Line : 7733 FORSYTH BLVD STE 2300
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63105-1806
Country : US
Telephone Number : 186-631-4394
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2009
Last Update Date : 04/02/2009

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Directions to “ VIJAYA KRISHNAMOORTHY OTR” Practice Location

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