MEDICARE: SHIMA GOLDSTONE OT,R/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	2021029711	MO

General Provider Information

NPI Number	:	1245905561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIMA GOLDSTONE OT,R/L

Provider Business Mailing Address
First Line	:	7815 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-3713
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7815 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-3713
Country	:	US
Telephone Number	:	443-386-5927
Fax Number	:

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

Provider Enumeration Date	:	08/09/2021
Last Update Date	:	08/10/2021

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