MEDICARE: MARIE KATHLEEN LANGE MOT, OTR/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	2007020783	MO

General Provider Information

NPI Number	:	1124285887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE KATHLEEN LANGE MOT, OTR/L

Provider Business Mailing Address
First Line	:	12063 RENAISSANCE DR
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-1145
Country	:	US
Telephone Number	:	913-909-7495
Fax Number	:

Provider Business Practice Location Address
First Line	:	5030 MCREE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-2046
Country	:	US
Telephone Number	:	314-776-1300
Fax Number	:

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

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	05/20/2008

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