MEDICARE: STRIDE THERAPY AND WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker
3	1041S0200X	School Social Worker
4	224Z00000X	Occupational Therapy Assistant
5	225100000X	Physical Therapist
6	225200000X	Physical Therapy Assistant
7	2355S0801X	Speech-Language Assistant
8	235Z00000X	Speech-Language Pathologist
9	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1962168443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRIDE THERAPY AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	8506 ANNA AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-5205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3407 S JEFFERSON AVE STE 145
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-3119
Country	:	US
Telephone Number	:	314-833-8848
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST, OWNER
Name	:	JIANNA D. FERNANDEZ
Credential	:
Telephone Number	:	314-319-0034

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	11/09/2021

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