MEDICARE: MRS. SARA ELIZABETH PARKS 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

General Provider Information

NPI Number	:	1710716436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA ELIZABETH PARKS OTR/L

Provider Business Mailing Address
First Line	:	5410 CHARGLOW CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-3546
Country	:	US
Telephone Number	:	314-541-6265
Fax Number	:

Provider Business Practice Location Address
First Line	:	5410 CHARGLOW CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-3546
Country	:	US
Telephone Number	:	314-541-6265
Fax Number	:

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

Provider Enumeration Date	:	07/31/2024
Last Update Date	:	07/31/2024

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