Individual
MADISON BANIAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1408 GRANITE RIDGE DR, SAINT PETERS, MO 63303-1621
(314) 306-1359
Mailing address
1408 GRANITE RIDGE DR, SAINT PETERS, MO 63303-1621
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2021007633
MO
Other
Enumeration date
06/21/2021
Last updated
06/21/2021
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