MEDICARE: MRS. ELIZABETH DENISE VAGO MBA,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	000605	MO

General Provider Information

NPI Number	:	1528258324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH DENISE VAGO MBA,OTR/L

Provider Business Mailing Address
First Line	:	13480 KINGSCROSS LN APT 3
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7254
Country	:	US
Telephone Number	:	314-681-1292
Fax Number	:

Provider Business Practice Location Address
First Line	:	11960 WESTLINE INDUSTRIAL DR
Second Line	:	SUITE 201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3209
Country	:	US
Telephone Number	:	314-819-0480
Fax Number	:	314-275-7444

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

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	01/12/2012

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