MEDICARE: MS. ANNE CLARE GRESICK 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	2012027533	MO
2	225X00000X	Occupational Therapist	009374	OH

General Provider Information

NPI Number	:	1316490329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE CLARE GRESICK OTR/L

Provider Business Mailing Address
First Line	:	433 ATALANTA AVE
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63119
Country	:	US
Telephone Number	:	314-422-1869
Fax Number	:

Provider Business Practice Location Address
First Line	:	633 ATALANTA AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-1948
Country	:	US
Telephone Number	:	314-422-1869
Fax Number	:

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

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	07/26/2016

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