MEDICARE: MRS. TINA PRESTON

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	225XP0200X	Pediatric Occupational Therapist	001475	MO

General Provider Information

NPI Number	:	1992842249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TINA PRESTON

Provider Business Mailing Address
First Line	:	811 QUEEN ANNE PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-3143
Country	:	US
Telephone Number	:	314-822-8051
Fax Number	:

Provider Business Practice Location Address
First Line	:	1170 TIMBER RUN DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4482
Country	:	US
Telephone Number	:	314-469-0606
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/09/2007

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