MEDICARE: MICHAEL BENDER OT

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	004823	MO

General Provider Information

NPI Number	:	1770512246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BENDER OT

Provider Business Mailing Address
First Line	:	11469 OLIVE BLVD
Second Line	:	#116
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-7108
Country	:	US
Telephone Number	:	314-291-9900
Fax Number	:	314-291-9909

Provider Business Practice Location Address
First Line	:	5240 OAKLAND AVE # A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1436
Country	:	US
Telephone Number	:	314-291-9900
Fax Number	:	314-291-9909

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	12/03/2015

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Directions to “ MICHAEL BENDER OT” Practice Location

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