MEDICARE: MRS. FREDIZMINDA CASTILLO TAMAYO-TSO OTL

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	0032792	MO

General Provider Information

NPI Number	:	1376681361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FREDIZMINDA CASTILLO TAMAYO-TSO OTL

Provider Business Mailing Address
First Line	:	2366 CEDAR LAKE DRIVE
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043
Country	:	US
Telephone Number	:	314-576-7327
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 HACKMANN RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-5452
Country	:	US
Telephone Number	:	636-851-6200
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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