MEDICARE: MS. STEPHANIE PATTON

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	261QA0600X	Adult Day Care Clinic/Center	293342200	MO

General Provider Information

NPI Number	:	1164680450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE PATTON

Provider Business Mailing Address
First Line	:	7271 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-2323
Country	:	US
Telephone Number	:	314-283-1335
Fax Number	:

Provider Business Practice Location Address
First Line	:	7271 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-2323
Country	:	US
Telephone Number	:	314-283-1335
Fax Number	:

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

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	05/23/2008

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Directions to “ MS. STEPHANIE PATTON ” Practice Location

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