MEDICARE: SYDNEY POGUE 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	2014027172	MO

General Provider Information

NPI Number	:	1336533801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY POGUE OTR/L

Provider Business Mailing Address
First Line	:	16765 MARCROSS CT
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-4823
Country	:	US
Telephone Number	:	314-660-4660
Fax Number	:

Provider Business Practice Location Address
First Line	:	2743 RUSSELL BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-2137
Country	:	US
Telephone Number	:	314-424-2948
Fax Number	:

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

Provider Enumeration Date	:	03/23/2015
Last Update Date	:	03/23/2015

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