MEDICARE: TARA CHRISTINE SIELFLEISCH

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	2023001971	MO

General Provider Information

NPI Number	:	1558144261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA CHRISTINE SIELFLEISCH

Provider Business Mailing Address
First Line	:	5367 FERN BEACH RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-3220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5367 FERN BEACH RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-3220
Country	:	US
Telephone Number	:	314-413-8813
Fax Number	:

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

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	08/16/2023

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Directions to “ TARA CHRISTINE SIELFLEISCH ” Practice Location

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