MEDICARE: KISCHA MOTON

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	224Z00000X	Occupational Therapy Assistant	057003075	IL
2	224Z00000X	Occupational Therapy Assistant	2009012937	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326309774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISCHA MOTON

Provider Business Mailing Address
First Line	:	3019 LINCOLN AVE
Second Line	:
City	:	EAST SAINT LOUIS
State	:	IL
Zip	:	62204-1110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3019 LINCOLN AVE
Second Line	:
City	:	EAST SAINT LOUIS
State	:	IL
Zip	:	62204-1110
Country	:	US
Telephone Number	:	618-581-6638
Fax Number	:

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

Provider Enumeration Date	:	06/01/2012
Last Update Date	:	06/01/2012

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Directions to “ KISCHA MOTON ” Practice Location

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