MEDICARE: LEAH MARIE MUNTGES MOTR/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	2010029470	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2010029470	OTHER	MO	STATE OF MISSOURI, MISSOURI BOARD OF HEALING ARTS

General Provider Information

NPI Number	:	1285907956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH MARIE MUNTGES MOTR/L

Provider Business Mailing Address
First Line	:	5210 NOTTINGHAM AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2963
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5210 NOTTINGHAM AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2963
Country	:	US
Telephone Number	:	314-791-5906
Fax Number	:

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

Provider Enumeration Date	:	02/10/2012
Last Update Date	:	02/10/2012

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